[Right ventricular infarction/ischemia with precordial ST elevation: comparison with left ventricular anterior wall...

Acute right ventricular (RV) infarction is sometimes accompanied by precordial ST elevation which is also suggestive of left ventricular (LV) anterior wall infarction. We compared 12-lead electrocardiograms between 2 groups of patients with initial acute myocardial infarction presenting precordial ST elevation, one with RV infarction (n = 11) and the other with LV anterior wall infarction (n = 42). The magnitude and extent of the ST elevation and the positions presenting the maximal ST elevation in the precordial leads differed between the 2 groups. In the inferior and lateral leads, the analysis of the ST segment shift aided in distinguishing between the 2 groups. The specific patterns of intraventricular conduction delay and frontal QRS-axis deviation were also useful for the differentiation. The best electrocardiographic variable for identifying RV infarction was inferior lead ST elevation, followed by maximal precordial ST elevation in lead V1, ST elevation limited to only one precordial lead and a cove-shaped pattern of RV conduction delay. The best electrocardiographic predictor for diagnosing LV anterior wall infarction was an isoelectric or depressed ST-segment in the inferior leads, followed by precordial ST elevation equal to or greater than 5 mm, maximal ST elevation in lead V3 or V4 and ST elevation in the lateral leads. We concluded that systematic analysis of the 12-lead electrocardiograms recorded in the hyperacute stage is valuable for distinguishing between acute RV infarction and LV anterior wall infarction.