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

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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

Won Young Kim1, Jong Sung Park, Won Kim

  • 1Department of Emergency Medicine, The Armed Forces Capital Hospital, Seongnam, Korea.

Korean Circulation Journal
|June 2, 2010
PubMed

Insights

ST segment elevation and Q waves on right-sided chest electrocardiograms (ECGs) are common in healthy Korean adults. These findings, particularly in leads V3R and V4R, are generally not indicative of infarction in this population.

Area of Science:

  • Cardiology
  • Electrocardiography
  • Diagnostic Imaging

Background:

  • Right-sided chest electrocardiograms (ECGs) are crucial for diagnosing combined right ventricular infarction in inferior wall infarction cases.
  • Normal patterns of right-sided chest ECGs in healthy adults are not well-established.
  • This study investigated normal ECG patterns and ST segment elevation (STE) prevalence in right-sided precordial leads (V3R, V4R) among healthy Korean adults.

Purpose of the Study:

  • To analyze normal electrocardiogram (ECG) patterns in right-sided precordial leads (V3R and V4R) in healthy adult Koreans.
  • To determine the prevalence of ST segment elevation (STE) in leads V3R and V4R in this population.
  • To establish baseline ECG characteristics for differentiating normal findings from pathology.

Main Methods:

  • 130 healthy male volunteers were enrolled.
  • Standard 12-lead ECGs and right-sided precordial ECGs were recorded.
  • QRS complex configuration, STE, and T wave morphology in right-sided leads were analyzed.

Main Results:

  • The most frequent QRS pattern in right-sided precordial leads was rS.
  • Q waves occurred in lead V4R in 4.6% of participants.
  • STE (0.5-1 mm) was observed in 25.4% of V3R and 6.2% of V4R recordings; T waves were typically negative, but positive with STE in V4R.
  • Significant correlations were found between V4R STE and STE in leads II, III, aVF, V1, V3, and V6 (p<0.01).

Conclusions:

  • ST segment elevation, Q waves, and T wave inversions in V3R and V4R are common in young, healthy Korean adults.
  • No cases presented with STE ≥1 mm concurrently with a q wave.
  • These findings suggest that certain STE and Q wave patterns in right-sided precordial leads can be normal variants in this demographic.
Abstract

Keywords:
ElectrocardiogramMyocardial infarctionPattern

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