Right ventricular myocardial infarction electrocardiogram: Difference between revisions
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=== Electrocardiogram === | === Electrocardiogram === | ||
* In addition to evidence of an acute [[Acute myocardial infarction|inferior]] or [[Acute myocardial infarction|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 <ref>Isner, JM. Right ventricular myocardial infarction. JAMA 1988; 259:712. PMID 3275819</ref> <ref>Kinch, JW, Ryan, TJ. Right ventricular infarction. N Engl J Med 1994; 330:1211. PMID 8139631</ref> <ref>Zehender, M, Kasper, W, Kauder, E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328:981. PMID 8450875</ref> 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 <ref>Zehender, M, Kasper, W, Kauder, E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328:981. PMID 8450875.</ref> | * In addition to evidence of an acute [[Acute myocardial infarction|inferior]] or [[Acute myocardial infarction|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 <ref>Isner, JM. Right ventricular myocardial infarction. JAMA 1988; 259:712. PMID 3275819</ref> <ref>Kinch, JW, Ryan, TJ. Right ventricular infarction. N Engl J Med 1994; 330:1211. PMID 8139631</ref> <ref>Zehender, M, Kasper, W, Kauder, E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328:981. PMID 8450875</ref> and correlates closely with occlusion of the proximal [[right coronary artery]]. | |||
[[Pulmonary embolism]], [[pericarditis]], and [[Acute myocardial infarction||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 myocardial infarction|right ventricular infarction]] cannot be made when one of these conditions is present <ref>Williams, JF. Right ventricular infarction. Clin Cardiol 1990; 13:309. PMID 2189611</ref> <ref>Kahn, JK, Bernstein, M, Bengston, JR. Isolated right ventricular myocardial infarction. Ann Intern Med 1993; 118:708. PMID 8460858</ref> | * 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 <ref>Zehender, M, Kasper, W, Kauder, E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328:981. PMID 8450875.</ref> | ||
* [[Pulmonary embolism]], [[pericarditis]], and [[Acute myocardial infarction||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 myocardial infarction|right ventricular infarction]] cannot be made when one of these conditions is present <ref>Williams, JF. Right ventricular infarction. Clin Cardiol 1990; 13:309. PMID 2189611</ref> <ref>Kahn, JK, Bernstein, M, Bengston, JR. Isolated right ventricular myocardial infarction. Ann Intern Med 1993; 118:708. PMID 8460858</ref> | |||
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Revision as of 02:34, 12 September 2012
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Right ventricular myocardial infarction Microchapters |
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Differentiating Right ventricular myocardial infarction from other Diseases |
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Diagnosis |
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Treatment |
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Pharmacological Reperfusion |
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Mechanical Reperfusion |
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Antithrombin Therapy |
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Antiplatelet Agents |
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Other Initial 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 [1] [2] [3] 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 [4]
- 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 [5] [6]
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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
References
- ↑ Isner, JM. Right ventricular myocardial infarction. JAMA 1988; 259:712. PMID 3275819
- ↑ Kinch, JW, Ryan, TJ. Right ventricular infarction. N Engl J Med 1994; 330:1211. PMID 8139631
- ↑ Zehender, M, Kasper, W, Kauder, E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328:981. PMID 8450875
- ↑ Zehender, M, Kasper, W, Kauder, E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328:981. PMID 8450875.
- ↑ Williams, JF. Right ventricular infarction. Clin Cardiol 1990; 13:309. PMID 2189611
- ↑ Kahn, JK, Bernstein, M, Bengston, JR. Isolated right ventricular myocardial infarction. Ann Intern Med 1993; 118:708. PMID 8460858