Patient handout

Isolated posterior wall STEMI (LCx / PDA culprit)

PRODUCTION

1. Your condition

This handout is for isolated posterior wall stemi (lcx / pda culprit). Your care team identified this based on: v1-v3 st↓ ≥0.5 mm + tall r waves v1-v2 (mirror image of posterior); confirm with v7-v9 st↑ ≥0.5 mm.

Other reasons your team may use this plan: v7-v9 posterior leads st↑ ≥0.5 mm = isolated true posterior stemi; ischemic chest pain + only v1-v3 st↓ — high suspicion for posterior stemi; obtain v7-v9 immediately.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	162-325 mg chewed	PO	load + 81 mg daily	ACC/AHA 2025 ACS Class I; same as parent
ticagrelor	180 mg load → 90 mg BID	PO	BID × 12 mo default DAPT	PLATO PMID 19717846; same as parent
unfractionated heparin	70-100 U/kg IV bolus then per ACT	IV	titrated	AHA 2025 Class I PCI anticoagulant; same as parent
atorvastatin	80 mg PO daily	PO	daily	PROVE-IT PMID 15007110; LDL goal <55 per AHA 2018 lipid (now <55 mg/dL secondary prevention)

Plan: Posterior STEMI complication phenotype — same regimen as parent cardio.stemi.core.v1; specialization centered on RECOGNITION + MR vigilance

3. When to call your provider

Contact your care team if any of the following happen:

Worsening MR → mitral repair eval
EF declining despite the four foundational heart-failure medications → advanced HF eval
Recurrent angina → cath re-eval

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Patient presents with ischemic chest pain + only V1-V3 ST↓ on standard 12-lead — high under-recognition risk; posterior leads NOT obtained → potential mis-classification as NSTEMI / unstable angina
New harsh apical/axillary holosystolic murmur post-posterior-MI + acute pulmonary edema → posteromedial papillary muscle ischemia/rupture(life-threatening)
Posterior STEMI extends to inferior territory → inferolateral / inferoposterior MI; complication profile expands to include AV block + RV extension
Posterior STEMI + SBP <90 + lactate ≥2 — large LCx territory or concurrent inferior involvement(life-threatening)

5. Follow-up

Cardiology follow-up; echo at 40 d for heart pumping strength (LVEF) reassessment + ICD eligibility (lower than anterior); cardiac rehab

6. Sources

Guideline: 2025 ACC/AHA ACS Guideline + ESC 2023 ACS + Boden 1991 + Khan 2013