ECG Case 001

General:

• Sinus rhythm, rate 84bpm
• Normal axis
• 1st degree AV block (PR 220ms)

Signs of inferior STEMI:

• STE in inferior leads II, III, aVF
• Reciprocal STD in lateral leads I, aVL, V6

Signs of associated right ventricular infarction:

• STE in III > II
• STE in V1-2

This patient also had STE in V4R, confirming the diagnosis of RV infarction:

• RV infarction complicates 40% of inferior STEMIs
• Suggestive features include:
  • ST elevation in V1, the only lead that looks directly at the RV
  • ST elevation in III > II, as lead III is more rightward facing
• Diagnosis can be confirmed with right-sided leads
• These patients are preload sensitive and may have an exaggerated hypotensive response to nitrates

Read more about diagnosing RV infarction and how to record the V4R lead

Further Reading

• Wiesbauer F, Kühn P. ECG Mastery: Yellow Belt online course. Understand ECG basics. Medmastery
• Wiesbauer F, Kühn P. ECG Mastery: Blue Belt online course: Become an ECG expert. Medmastery
• Kühn P, Houghton A. ECG Mastery: Black Belt Workshop. Advanced ECG interpretation. Medmastery
• Rawshani A. Clinical ECG Interpretation ECG Waves
• Smith SW. Dr Smith’s ECG blog.
• Wiesbauer F. Little Black Book of ECG Secrets. Medmastery PDF