[Acute myocardial infarction of the right ventricle: hemodynamic and electrocardiographic correlation (author's...

The electrocardiogram as a diagnostic aid in acute myocardial infarction of the right ventricle (AMI-RV) was studied prospectively in a group of 66 patients in our coronary unit. Diagnosis was AMI in all cases, divided into 29 (44%) with posterior-descending and 35 (53%) with anterior location. Electrocardiography was practiced with standard and special modes: CRnR, CR and VR. Thirty-nine patients were hemodynamically monitored. In 13 patients with posterior-descending location (19.6%) the hemodynamic pattern disclosed AMI. Right ventricular dysfunction was found in 17%, left ventricular dysfunction in 9% and biventricular dysfunction in 20%. In 30 patients (45.5%) ST increased to greater than 1 mm CR3R-CR6R of which 77% were false positive and 46% false negative. No improvement in these proportions was observed with the use of special mode, special in infarctions with anterior location. The correlation between hemodynamics-site of necrosis was better than that between hemodynamics-increase in ST in CRnR. The authors draw the conclusion that special modes as an aid to diagnosis are of limited value, sensitivity is 54% and specificity is 23%, which rises to 50% in posterior-descending infarctions. At present hemodynamics are the choice diagnostic procedure for AMI-RV which must be suspected if serial studies disclose PVC of more than 9 mm Hg.