Tuesday, February 14, 2017

Acute Right Ventricular Myocardial Infarction - ECG

Right Ventricular Myocardial Infarction. This ECG was obtained with right-sided lead placement.

ECG Findings
• ST elevation in right-sided V leads (V4R, V5R).
• ST elevation greater in lead III than lead II suggests RV MI.
• ST elevation in the normally obtained V1 also strongly suggests RV MI.

• Often associated with inferior MI and/or posterior MI.

ST elevation in V4R and V5R (arrows), with the V4 and V5 leads placed in their mirror-image locations on the right side of the chest. Any ST elevation seen in the right-sided precordial leads is significant.

Important Points: 
1. The smaller muscle mass of the right ventricle produces a less intense injury pattern that is
overwhelmed by the left ventricle in the normally obtained ECG. Placement of right-sided V leads, with V1-V6 in mirror-image locations on the right side of the chest, is important in detecting
right ventricular injury.
2. The heart with an injured right ventricle is very preload dependent. Beware of lowering preload with nitrates in any patient with suspected RV MI as severe hypotension may occur. Treat hypotension with volume.
3. Obtain a right-sided ECG in any patient with inferior or posterior MI, and in any patient with a significant hypotensive response to nitrates

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