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S-T segment depression in right-sided precordial leads during acute inferior wall infarction
E Rechavia1, B Strasberg, N Zafrir
1Israel and Ione Massada Center for Heart Diseases, Beilinson Medical Center, Petah Tiqva, Israel.
Insights
Right-sided chest leads in acute myocardial infarction (AMI) can indicate right ventricular (RV) involvement. ST-segment depression, not just elevation, in V3-V4R warrants further assessment for RV infarction.
Area of Science:
- Cardiology
- Diagnostic Electrocardiography
- Myocardial Infarction
Background:
- Inferior wall acute myocardial infarction (AMI) can involve the right ventricle (RV).
- Electrocardiogram (ECG) findings in RV infarction typically include ST-segment elevation in right precordial leads.
- The diagnostic significance of ST-segment depression in right precordial leads during inferior AMI is less understood.
Purpose of the Study:
- To investigate the prevalence and implications of ST-segment depression in right-sided chest leads (V3-V4R) in patients with their first inferior wall AMI.
- To determine if ST-segment depression in V3-V4R is associated with right ventricular infarction.
Main Methods:
- 100 consecutive patients with first inferior wall AMI were included.
- Right-sided chest leads (V3-V4R) were recorded.
- Patients with ST-segment depression (>1 mm) in V3-V4R underwent echocardiography and radionuclear angiography.
Main Results:
- 9% of patients (9 out of 100) showed ST-segment depression in V3-V4R.
- Of these 9 patients, 5 had intact RV function, while 4 showed clinical findings consistent with RV infarction.
- This suggests a potential association between ST-segment depression in right precordial leads and RV infarction.
Conclusions:
- ST-segment depression in right precordial leads (V3-V4R) during inferior wall AMI should not be overlooked.
- This ECG pattern may indicate right ventricular involvement, even without ST-segment elevation.
- Individual assessment for RV infarction is recommended when ST-segment depression is observed in V3-V4R in the context of inferior AMI.
Abstract:
Right-sided chest leads (V3-V4R) were recorded in the early stages of first inferior wall acute myocardial infarction (AMI) in 100 consecutive patients. Nine patients (9%) presenting with S-T segment depression (greater than 1 mm) in these leads were subsequently studied by echocardiography and radionuclear angiography. In this group, there were 5 patients with intact right ventricular (RV) function and 4 other patients with clinical findings compatible with RV infarction. We suggest that one should not rule out RV involvement when S-T segment depression rather than elevation is seen in the right precordial leads in the presence of inferior wall AMI. An individual assessment for RV infarction is recommended when this pattern is apparent on the ECG.