ECGbook.com

Making Medical Education Free for All

ECGbook.com

Making Medical Education Free for All

Home /

Right Ventricular STEMI Infarction

Right ventricular STEMI infarction

Right Coronary Artery

Right ventricular STEMI infarction, right coronary artery dominance
  • The anterior wall is supplied by the anterior interventricular branch (AIV)
  • The inferior wall is supplied by the posterior interventricular branch (PIV)
  • Right Coronary Artery Dominance
    • 70% of people have a dominant right coronary artery (RCA)
    • PIV originates from the right coronary artery
    • Proximal occlusion of RCA leads to a myocardial infarction:
  • Left Coronary Artery Dominance
    • 10% of people have a dominant left coronary artery (LCA)
    • PIV originates from the left coronary artery (from LCx)
    • Proximal occlusion of LCA results in an isolated right ventricular infarction
      • Because the inferior wall is supplied through PIV from the LCA (via LCx)

Right Ventricular Infarction

Right ventricular and inferior ventricular infarction, occlusion proximal right coronary artery, culprit RCA

Inferior Wall Infarction

ECG right and inferior STEMI infarction

Right-sided Leads (V4R-V6R)

ECG (V3R-V6R) right-sided leads, isolated RVMI, culprit vessel, ischemic electrical vector

V4R and Inferior STEMI

Right coronary artery, left circumflex artery, culprit vessel, ECG V4R lead
  • Lead V4R helps to locate the occlusion in inferior STEMI
  • Based on the ST segment (V4R), it is possible to localize:
    • Proximal occlusion of the right coronary artery (RCA)
    • Distal occlusion of the right coronary artery (RCA)
    • Occlusion of the left circumflex artery (LCx)


Proximal RCA Occlusion



ECG (V4R) ST elevation, inferior right STEMI infarction, culprit vessel: Proximal right coronary artery occlusion Proximal right coronary artery occlusion, right STEMI infarction, left circumflex artery, culprit vessel, ECG (V4R lead)


Distal RCA Occlusion



ECG (V4R) ST isoelectric, isolated inferior STEMI infarction, culprit vessel, distal right coronary artery
  • Isoelectric ST segment in V4R
  • The patient has isolated
Distal right coronary artery occlusion, right STEMI infarction, inferior STEMI infarction, left circumflex artery, culprit vessel, ECG (V4R lead)


Left Circumflex Occlusion



ECG (V4R) ST depression, inferior-lateral STEMI infarction, culprit vessel, left circumflex artery Left circumflex artery occlusion, inferior STEMI infarction, culprit vessel, ECG (V4R lead)

ECG and Right Ventricular STEMI

ECG (V4R) criteria, right ventricular STEMI infarction
  • In right-sided leads (V1, V2), there can be 3 variants:
    • ST Elevation in V1 and V2
      • ST elevation V1 > V2
    • ST Elevation in V1 and ST Depression in V2
    • Isoelectric ST in V1 and ST Depression in V2

  • When suspecting right ventricular STEMI, right-sided leads (V3R-V6R) are placed
    • ST Elevation ≥ 0.5mm (V3R-V4R)
      • For both men and women
    • ST Elevation ≥ 1mm (V3R-V4R)
      • For men < 30 years old


heart coronary supply, proximal right coronary artery (RCA) occlusion
ECG inferior and right ventricular infarction STEMI, ST elevation, reciprocal ST depression

Acute Inferior and Right Ventricular STEMI



heart coronary supply, proximal right coronary artery (RCA) occlusion
ECG acute inferior and right ventricular STEMI infarction, ST elevation (V1), ST elevation (V3R-V6R)

Acute Inferior and Right Ventricular STEMI

  • Sinus Rhythm
  • Inferior STEMI
    • ST Elevations (II, III, aVF)
    • ST Elevation III > II (indicates RCA occlusion)
    • Significant reciprocal ST depressions (I, aVL)
  • Right Ventricular STEMI
    • ST Elevation (V1)
      • Possible ST Depression (V2)
    • ST Elevations in right-sided leads > 1 mm (V3R-V6R)
  • On coronary angiography there was:
    • proximal occlusion of the dominant right coronary artery (RCA)


heart coronary supply, proximal right coronary artery (RCA) occlusion
ECG acute inferior (ST elevation II, III, aVF) and right ventricular STEMI (ST elevation V4R) infarction

Acute Inferior and Right Ventricular STEMI



heart coronary supply, proximal right coronary artery (RCA) occlusion
ECG acute inferior (ST elevation II, III, aVF) and right ventricular STEMI (ST elevation V3R-V6R) infarction

Acute Inferior and Right Ventricular STEMI

  • Sinus Rhythm
  • Inferior STEMI
    • ST Elevations (II, III, aVF)
    • ST Elevation III > II (indicates RCA occlusion)
    • Significant reciprocal ST depressions (I, aVL)
  • Right Ventricular STEMI
    • Isoelectric ST Segment (V1)
      • ST Depression (V2)
    • ST Elevations in right-sided leads > 1 mm (V3R-V6R)
  • On coronary angiography there was:
    • proximal occlusion of the dominant right coronary artery (RCA)



Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers





šípka späť

Home /

Right Ventricular STEMI Infarction

Right ventricular STEMI infarction

Right Coronary Artery

  • The anterior wall is supplied by the anterior interventricular branch (AIV)
  • The inferior wall is supplied by the posterior interventricular branch (PIV)
  • Right Coronary Artery Dominance
    • 70% of people have a dominant right coronary artery (RCA)
    • PIV originates from the right coronary artery
    • Proximal occlusion of RCA leads to a myocardial infarction:
  • Left Coronary Artery Dominance
    • 10% of people have a dominant left coronary artery (LCA)
    • PIV originates from the left coronary artery (from LCx)
    • Proximal occlusion of LCA results in an isolated right ventricular infarction
      • Because the inferior wall is supplied through PIV from the LCA (via LCx)

Right ventricular STEMI infarction, right coronary artery dominance

Right Ventricular Infarction

  • The right ventricle is supplied by proximal branches of the right coronary artery
  • Right ventricular infarction (RV) often occurs along with inferior wall infarction
    • 40% of inferior wall infarctions also involve right ventricular infarction
      • Due to proximal occlusion of the dominant RCA
    • Isolated right ventricular infarction is very rare
      • Because it requires a proximal occlusion of a non-dominant RCA
  • Diagnosing RV infarction is crucial for treatment
    • RV infarction should not be treated with nitrates
      • Patients often have hypotension due to reduced contractility of the RV
      • Nitrates exacerbate this hypotension (reduce preload)
  • Always consider RV infarction in the case of inferior wall infarction
  • ST elevations in right ventricular STEMI
    • Last for a maximum of 10 hours
  • ST elevations in left ventricular STEMI
    • Can persist for up to 2 weeks
    • Because the myocardium of the left ventricle is more massive

Right ventricular and inferior ventricular infarction, occlusion proximal right coronary artery, culprit RCA

Inferior Wall Infarction
ECG right and inferior STEMI infarction

Right-sided Leads (V4R-V6R)

  • When suspecting right ventricular STEMI, the following steps are taken:
    • Place right-sided precordial leads (V3R-V6R)
      • V3R-V6R are mirror-image of the precordial leads V3-V6
    • Lead V4R looks directly at the right ventricle
ECG (V3R-V6R) right-sided leads, isolated RVMI, culprit vessel, ischemic electrical vector

V4R and Inferior STEMI

  • Lead V4R helps to locate the occlusion in inferior STEMI
  • Based on the ST segment (V4R), it is possible to localize:
    • Proximal occlusion of the right coronary artery (RCA)
    • Distal occlusion of the right coronary artery (RCA)
    • Occlusion of the left circumflex artery (LCx)
Right coronary artery, left circumflex artery, culprit vessel, ECG V4R lead



ECG (V4R) ST elevation, inferior right STEMI infarction, culprit vessel: Proximal right coronary artery occlusion

Proximal RCA Occlusion

  • ST elevation in V4R ≥ 1mm
  • The patient has simultaneously
Proximal right coronary artery occlusion, right STEMI infarction, left circumflex artery, culprit vessel, ECG (V4R lead)



ECG (V4R) ST isoelectric, isolated inferior STEMI infarction, culprit vessel, distal right coronary artery

Distal RCA Occlusion

  • Isoelectric ST segment in V4R
  • The patient has isolated
Distal right coronary artery occlusion, right STEMI infarction, inferior STEMI infarction, left circumflex artery, culprit vessel, ECG (V4R lead)


ECG (V4R) ST depression, inferior-lateral STEMI infarction, culprit vessel, left circumflex artery

Left Circumflex Occlusion
Left circumflex artery occlusion, inferior STEMI infarction, culprit vessel, ECG (V4R lead)

ECG and Right Ventricular STEMI

  • In right-sided leads (V1, V2), there can be 3 variants:
    • ST Elevation in V1 and V2
      • ST elevation V1 > V2
    • ST Elevation in V1 and ST Depression in V2
    • Isoelectric ST in V1 and ST Depression in V2

  • When suspecting right ventricular STEMI, right-sided leads (V3R-V6R) are placed
    • ST Elevation ≥ 0.5mm (V3R-V4R)
      • For both men and women
    • ST Elevation ≥ 1mm (V3R-V4R)
      • For men < 30 years old

ECG (V4R) criteria, right ventricular STEMI infarction


ECG inferior and right ventricular infarction STEMI, ST elevation, reciprocal ST depression

Acute Inferior and Right Ventricular STEMI

  • Sinus Rhythm
  • Inferior STEMI
    • ST Elevations (II, III, aVF)
    • ST Elevation III > II (suggests RCA occlusion)
    • Significant reciprocal ST depressions (I, aVL)
  • Right Ventricular STEMI
    • ST Elevations (V1)
      • Possible ST Depression (V2)
    • The patient should have a right-sided lead V4R placed
  • This indicates a proximal occlusion of the dominant right coronary artery (RCA)
 heart coronary supply, proximal right coronary artery (RCA) occlusion


ECG acute inferior and right ventricular STEMI infarction, ST elevation (V1), ST elevation (V3R-V6R)

Acute Inferior and Right Ventricular STEMI

  • Sinus Rhythm
  • Inferior STEMI
    • ST Elevations (II, III, aVF)
    • ST Elevation III > II (indicates RCA occlusion)
    • Significant reciprocal ST depressions (I, aVL)
  • Right Ventricular STEMI
    • ST Elevation (V1)
      • Possible ST Depression (V2)
    • ST Elevations in right-sided leads > 1 mm (V3R-V6R)
  • On coronary angiography there was:
    • proximal occlusion of the dominant right coronary artery (RCA)
 heart coronary supply, proximal right coronary artery (RCA) occlusion


ECG acute inferior (ST elevation II, III, aVF) and right ventricular STEMI (ST elevation V4R) infarction

Acute Inferior and Right Ventricular STEMI

  • Sinus Rhythm
  • AV Block I
  • Inferior STEMI
    • ST Elevations (II, III, aVF)
    • ST Elevation III > II (indicates RCA occlusion)
    • Significant reciprocal ST depressions (I, aVL)
  • Right Ventricular STEMI
    • Isoelectric ST Segment (V1)
      • ST Depression (V2)
    • ST Elevation in right-sided lead > 1 mm (V4R)
  • On coronary angiography there was:
    • proximal occlusion of the dominant right coronary artery (RCA)
 heart coronary supply, proximal right coronary artery (RCA) occlusion


ECG acute inferior (ST elevation II, III, aVF) and right ventricular STEMI (ST elevation V3R-V6R) infarction

Acute Inferior and Right Ventricular STEMI

  • Sinus Rhythm
  • Inferior STEMI
    • ST Elevations (II, III, aVF)
    • ST Elevation III > II (indicates RCA occlusion)
    • Significant reciprocal ST depressions (I, aVL)
  • Right Ventricular STEMI
    • Isoelectric ST Segment (V1)
      • ST Depression (V2)
    • ST Elevations in right-sided leads > 1 mm (V3R-V6R)
  • On coronary angiography there was:
    • proximal occlusion of the dominant right coronary artery (RCA)
 heart coronary supply, proximal right coronary artery (RCA) occlusion



Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers