About-Cardio
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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Right Ventricular Infarction and ECG Findings
Introduction
Right ventricular (RV) infarction is a serious condition often associated with inferior wall myocardial infarction (MI). It occurs due to occlusion of the right coronary artery (RCA), leading to impaired RV function and systemic hypotension. Early recognition using ECG is critical for appropriate management.
ECG Findings in RV Infarction
The hallmark of RV infarction on ECG is ST-segment elevation in right-sided precordial leads. Key findings include:
- Inferior MI Pattern: Since RV infarction often coexists with inferior MI, look for ST-segment elevation in leads II, III, and aVF.
- Right-Sided Lead Placement:
- ST-segment elevation in V4R is the most specific finding for RV infarction.
- Leads V3R to V6R may also show ST elevation.
- ST-Segment Depression in Left Precordial Leads: Reciprocal ST-segment depression in V1-V3 is common.
- Bradycardia and Hypotension: Due to vagal stimulation or dysfunction of the sinoatrial (SA) node from ischemia.
Clinical Importance
- Patients with RV infarction are preload-dependent, meaning they require adequate volume resuscitation.
- Avoid nitroglycerin and diuretics, as they can cause severe hypotension.
- Early identification and reperfusion therapy (PCI or thrombolysis) are crucial for improving outcomes.
Diagnostic Approach
- Obtain a standard 12-lead ECG first.
- If inferior MI is present, immediately obtain right-sided leads, focusing on V4R.
- Perform echocardiography to assess RV function if ECG findings are unclear.
Conclusion
Right ventricular infarction requires urgent ECG identification and appropriate management. Recognizing ST elevation in lead V4R and avoiding preload-reducing medications are key aspects of treatment.
Source recommendations
1. American Heart Association (AHA) Guidelines on the Management of ST-Elevation Myocardial Infarction (STEMI)
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309
- https://professional.heart.org/en/science-news/2021-acc-aha-scai-guideline-for-coronary-artery-revascularization
- https://www.ahajournals.org/doi/10.1161/01.cir.0000134791.68010.fa
- https://pubmed.ncbi.nlm.nih.gov/23256914/
- https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6
2. European Society of Cardiology (ESC) Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation
- https://pubmed.ncbi.nlm.nih.gov/26320110/
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
- https://pubmed.ncbi.nlm.nih.gov/32860058/
- https://academic.oup.com/eurheartj/article/42/14/1289/5898842
- https://pubmed.ncbi.nlm.nih.gov/21873419/
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
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