An ECG marker of underlying right ventricular conduction delay in the hyperacute phase of right ventricular infarction or ischemia

Patients with extensive right ventricular (RV) infarction or ischemia often have an accompanying RV conduction delay. Such patients frequently show precordial ST-T wave elevation, which hides the late r' wave in lead V1, making it difficult to recognize the RV conduction delay during the hyperacute phase. We noted that such patients occasionally exhibited a "cove"-shaped ST-T elevation in lead V1, which strongly suggested the presence of this complication even in the hyperacute stage. This report describes three instances of RV infarction or ischemia with this characteristic electrocardiographic sign. This sign appears to be a marker of RV conduction delay during the hyperacute stage of RV infarction or ischemia.