Right ventricular myocardial infarction electrocardiogram

Right ventricular myocardial infarction Microchapters
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Epidemiology and Demographics
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Natural History, Complications and Prognosis
Diagnosis
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History and Symptoms
Physical Examination
Electrocardiogram
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Treatment
Initial Care
Pharmacological Reperfusion
Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)
Fibrinolysis
Mechanical Reperfusion
The Importance of Reducing Door-to-Balloon Times
Primary PCI
Adjunctive and Rescue PCI
Rescue PCI
Facilitated PCI
Adjunctive PCI
CABG
Management of Patients Who Were Not Reperfused
Assessing Success of Reperfusion
Antithrombin Therapy
Antithrombin Therapy
Unfractionated Heparin
Low Molecular Weight Heparinoid Therapy
Direct Thrombin Inhibitor Therapy
Factor Xa Inhibition
DVT Prophylaxis
Long Term Anticoagulation
Antiplatelet Agents
Aspirin
Thienopyridine Therapy
Glycoprotein IIbIIIa Inhibition
Other Initial Therapy
Inhibition of the Renin-Angiotensin-Aldosterone System
Magnesium Therapy
Glucose Control
Calcium Channel Blocker Therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The diagnosis can be made using a right-sided electrocardiogram, on which ST-segment elevation in leads V3R and V4R will be seen.

Electrocardiogram

• In addition to evidence of an acute inferior or inferoposterior myocardial infarction, the ECG may demonstrate > or =1 mm of doming ST elevation in the right sided precordial leads V4R to V6R. Right sided ST elevation, particularly in V4R, is indicative of acute right ventricular injury and correlates closely with occlusion of the proximal right coronary artery. In one report of patients with acute inferior infarction, for example, ST elevation in V4R had 88 percent sensitivity and 78 percent specificity for concurrent right ventricular infarction

Pulmonary embolism, pericarditis, and |anteroseptal myocardial infarction also cause elevation of the ST segment in the right-sided precordial leads. As a result, an electrocardiographic diagnosis of right ventricular infarction cannot be made when one of these conditions is present

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  12 lead ECG shows Inferior MI + Right ventricular MI
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  ST elevation at V4R on same patient's EKG (obtained from right precordial leads).

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  Right ventricular MI
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  Right ventricular MI