Value of lead V4R for recognition of the infarct coronary artery in acute inferior myocardial infarction

Braat, Simon H.; Brugada, Pedro; Dulk, Karel den; Ommen, Vincent van; Wellens, Hein J.J.

doi:10.1016/0002-9149(84)90575-7

Cited by 98 publications

(19 citation statements)

References 10 publications

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“…Braat et al [7]reported that right-sided leads aided in identifying the infarct artery and site of its occlusion in inferior MI. Subsequent studies have confirmed these investigations, and the use of right-sided leads to assess right ventricular involvement in acute inferior MI is now standard practice [15].…”

Section: Discussionmentioning

confidence: 99%

“…The value of additional ECG leads is well established in high-risk populations evaluated by previously reported techniques [6, 7, 8, 9, 10, 11, 12]. It was our purpose to assess the utility of additional leads in low-risk patients because missed acute coronary syndromes are a continuing problem in this group [13].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a number of innovative approaches have been investigated for their value in the early detection of acute ischemia or MI in patients presenting to the emergency department (ED) with chest pain suggestive of a cardiac origin [5]. Previous studies have demonstrated that right precordial and posterior ECG leads are useful for identifying acute right ventricular and posterior MI, respectively, not detected by the standard 12-lead ECG [6, 7, 8, 9, 10, 11, 12]. However, the utility of these additional ECG leads has not been evaluated in low-risk patients presenting to the ED with symptoms suggestive of acute coronary syndromes who are managed in a chest pain evaluation unit (CPEU).…”

Section: Introductionmentioning

confidence: 99%

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Right Precordial and Posterior Electrocardiographic Leads Do Not Increase Detection of Ischemia in Low-Risk Patients Presenting with Chest Pain

et al. 2004

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Background: A number of innovative approaches have been investigated for their value in the early detection of acute ischemia or infarction in patients presenting to the emergency department (ED) with chest pain suggestive of a cardiac origin. Prior investigations have demonstrated the utility of adding right precordial and posterior chest leads to the standard 12-lead electrocardiogram (ECG) for identifying right ventricular and posterior wall infarctions in the ED. Hypothesis: To assess the utility of additional ECG leads in low-risk patients presenting to the ED with symptoms suggestive of acute coronary syndromes who are managed in a chest pain evaluation unit (CPEU). Methods: We studied low-risk patients who presented to the ED with chest pain compatible with myocardial ischemia. Low-risk patients were identified by a normal 12-lead ECG, no arrhythmias or hemodynamic instability, and one negative serum cardiac troponin I. Patients were admitted to the CPEU where a 16-lead ECG was recorded by the addition of 2 right-sided precordial leads (V4R, V5R) and 2 posterior leads (V8, V9) to the standard 12-lead ECG. Results: The 16-lead ECG system was applied to 316 consecutive patients. The study group was a middle-aged population with equal numbers of men and women and an average of 2 cardiac risk factors per patient. The 16-lead ECG demonstrated evidence of myocardial injury in only 1 patient and no evidence of ischemia in any of the 316 patients. Conclusion: In patients presenting to the ED with chest pain and evidence of low clinical risk by our criteria, the addition of both right-sided precordial and posterior chest leads to the standard 12-lead ECG did not provide additional information for risk stratification.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Right Precordial and Posterior Electrocardiographic Leads Do Not Increase Detection of Ischemia in Low-Risk Patients Presenting with Chest Pain

et al. 2004

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“…Several ECG criteria has been recommended for the IRA prediction with variable results. 4,5 Predicting the site of occlusion in RCA by ECG is worthwhile as proximal occlusion is likely to cause larger myocardial damage.…”

Section: Introductionmentioning

confidence: 99%

Correlation of Severity of ST Segment Elevation with Respect to the Site of Right Coronary Artery Lesion

Simkhada¹

2013

J Nepal Med Assoc

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Introduction: Electrocardiogram a widely available tool may predict infarct related artery in acute inferior wall myocardial infarction. Severity of ST segment elevation may correlate with proximity of lesion in right coronary artery.Methods: Patient with acute ST segment elevation inferior wall myocardial infarction who underwent coronary angiogram was studied. Differences in electrocardiogram among right coronary and left circumflex groups were evaluated. Severity of ST segments elevation in relation to site of lesion in right coronary was studied.Results: The mean age of presentation was 59.52 ± 11.01 years. Total 36 (72%) were men. A total of 42 (84%) had lesion in right and 8 (16%) in left circumflex. Age, sex,diabetes,hypertension, smoking, dyslipidemia and physical activity showed no correlation with lesion in right or circumflex coronary artery. ST segment elevation in III>II (P=0.01), ST segment depression in AVL> I (P<0.01) and ST elevation in V4R (P=0.04), correlated with right coronary lesion. Sum of ST elevation in inferior leads were 10.90 ±1.30 mm for proximal, 7.38±1.19 mm for mid and 5.50± 0.53 mm for distal right coronary with significant correlation (P<0.01).Conclusions: Electrocardiogram was reliable tool to difference right and left circumflex lesion. Severity of sum of ST segment elevations in inferior leads correlated with the proximity of lesion in right coronary._______________________________________________________________________________________Keywords: acute inferior myocardial infarction; electrocardiogram; infarct related artery._______________________________________________________________________________________

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“…An early diagnosis of the concurrent presence of a right ventricular infarction during a medical evaluation would be clinically essential 2-5). Thus, many physicians have checked right-sided precordial leads (V3R and V4R leads) of patients with inferior myocardial infarctions to rule out right ventricular infarctions 6-8). However, the electrocardiogram (ECG) patterns from the right precordial leads in normal adults have not been thoroughly investigated.…”

Section: Introductionmentioning

confidence: 99%

Normal ST Segment Elevation and Electrocardiographic Patterns in the Right-Sided Precordial Leads (V3R and V4R) in Healthy Young Adult Koreans

2010

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Background and ObjectivesIt is important to analyze right-sided chest electrocardiograms (ECGs) to rule out combined right ventricular infarction in patients with inferior wall infarction. However, the patterns of right-sided chest ECGs in healthy adults have not been thoroughly investigated. This study was conducted to analyze the normal patterns of ECGs and the prevalence of ST segment elevation (STE) in the right-sided precordial leads (V3R and V4R) in healthy adult Koreans.Subjects and MethodsOne hundred thirty healthy male volunteers who registered at the Armed Forces Daejeon Hospital for military recruitment were enrolled between December 2006 and April 2007. Standard 12-lead ECGs and right-sided precordial ECGs were obtained. The characteristic features of the QRS complex configuration, STE, and T wave morphology from right-sided precordial ECGs were analyzed.ResultsThe most common QRS configuration in right-sided precordial leads was the rS pattern. The Q waves were present in lead V4R in 4.6% of the study population. STEs of 0.5-1 mm were present in 25.4% of V3R recordings and 6.2% of V4R recordings. T waves were usually negative in the right-sided precordial leads. However, if there was a STE in V4R, the associated T waves were usually positive. There were statistically significant correlations between STEs in V4R and STEs in II, III, aVF, V1, V3, and V6 (p<0.01).ConclusionThe STEs, Q waves, and T wave inversions in the V3R and V4R leads were relatively common findings in young, healthy, Korean adults. However, there were no cases in which there was a STE ≥1 mm and a STE concurrently with a q wave.

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Value of lead V4R for recognition of the infarct coronary artery in acute inferior myocardial infarction

Cited by 98 publications

References 10 publications

Right Precordial and Posterior Electrocardiographic Leads Do Not Increase Detection of Ischemia in Low-Risk Patients Presenting with Chest Pain

Right Precordial and Posterior Electrocardiographic Leads Do Not Increase Detection of Ischemia in Low-Risk Patients Presenting with Chest Pain

Correlation of Severity of ST Segment Elevation with Respect to the Site of Right Coronary Artery Lesion

Normal ST Segment Elevation and Electrocardiographic Patterns in the Right-Sided Precordial Leads (V3R and V4R) in Healthy Young Adult Koreans

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