Tuesday, February 14, 2017
Acute Right Ventricular Myocardial Infarction - ECG
• 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.
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