Middle-aged patient presenting with chest pain and diaphoresis. BP dropped to 80/50 following sublingual nitrates.
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
General:
- Sinus rhythm, rate 84bpm.
- Normal axis.
- Borderline 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:
CLINICAL PEARLS
- RV infarction typically occurs in the context of inferior STEMI due to RCA occlusion.
- These patients are preload sensitive and may have an exaggerated hypotensive response to nitrates.
Read more about RV infarction and how to record the V4R lead
TOP 100 ECG SERIES
LITFL posts by 
Adail Paixao Almeida says
November 23, 2018 at 12:17Dr. Burns
I find a interesting aspect in the ecg: ST ELEVATION V2>V3>V4
It’s important to know the result of coronariogram. Please give us this date. Thanks