Abstract: Objective For acute posterior wall myocardial infarction patients and healthy people，compared the routine lead ECG with head-chest lead ECG on diagnosis. Methods 36 acute posterior wall myocardial infarction patients and 52 healthy people were selected. Routine lead ECG and head-chest lead ECG were recorded simultaneously，and then the two kinds of ECG results were contrasted with coronarography confirmed diagnosis. The confirmed rates and false positive rates of diagnosis based on routine lead ECG and head-chest lead ECG were calculated by χ 2 test. Results For routine lead ECG and head-chest lead ECG，the confirmed rate were 88. 8% and 97. 22% in 36 patients of acute posterior wall myocardial infarction，and the false positive rate were 13. 4% and 3. 85% in 52 healthy people. There is a significant statistical difference（P < 0. 05）. Conclusion Head-chest lead ECG is better than routine lead ECG in the diagnosis of acute posterior wall myocardial infarction. It is worthy of clinical popularization.