The early recognition of right ventricular infarction: diagnostic accuracy of the electrocardiographic V4R lead.

Klein, Herman O.; Tordjman, Therese; R, Ninio; Sareli, Pinhas; Oren, V.; Lang, RM; Gefen, J; Pauzner, C; Segni, Elio Di; David, Daniel; Kaplinsky, Elieser

doi:10.1161/01.cir.67.3.558

Cited by 200 publications

(70 citation statements)

References 40 publications

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“…Given that the 24-lead ECG requires no additional electrodes, this method is also simpler than 16-lead ECG and should therefore be considered as an add-on to analysis of the 12-lead ECG. On the other hand, the present study might have underestimated the true sensitivity of the 16-lead ECG in detecting MI, because ST-segment elevation in rightsided chest leads is usually an early and transient phenomenon in right ventricular infarction (Braat et al, 1983;Klein et al, 1983). Leads V4R and V5R might be of greater value in emergency situations than indicated in the present study.…”

Section: Discussionmentioning

confidence: 55%

Detection of acute myocardial infarction using the 12‐lead ECG plus inverted leads versus the 16‐lead ECG (with additional posterior and right‐sided chest electrodes)

Trägårdh

Claesson

Wagner

et al. 2007

Clin Physio Funct Imaging

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SUMMARYBackground: The electrocardiographic (ECG) diagnosis of acute myocardial infarction (MI) should be improved. This might be done either by regarding all 24 aspects (both positive and negative leads), or a subset hereof (for example 19-lead ECG), of the conventional 12-lead ECG or by using additional electrodes. The purpose of the study was to investigate the accuracy of the different ECG methods in diagnosing acute ST-elevation MI.Methods: The study population consisted of 479 patients admitted to Lund University Hospital with acute chest pain. One conventional ECG plus leads V4R, V5R, V8, and V9 were recorded for each patient within 24 hours of admittance. Biochemical markers were used as the "gold standard" for diagnosis of MI. We measured STsegment elevations in the 12-lead, 16-lead, and 24-lead postadmission ECGs as well as in the 12-lead, 19-lead and 24-lead admission ECGs.Results: The sensitivity for detecting acute MI was 28% for the postadmission 12-lead ECG, 33% for the 16-lead ECG, and 37% for the 24-lead ECG. The specificities were 97%, 93%, and 95%, respectively. For admission ECGs, the sensitivity was 33% for the 12-lead ECG, 45% for the 19-lead ECG and 49% for the 24-lead ECG, with specificities of 97%, 96%, and 94%, respectively.Conclusions: The sensitivity for detecting acute MI was higher for the 16-, 19-and 24-lead ECGs than for the conventional 12-lead ECGs. Their specificity, however, was slightly lower. If increased sensitivity for detecting MI is desired, the 24-lead or 19-lead should be used since no additional electrodes are required.

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Section: Discussionmentioning

confidence: 55%

Detection of acute myocardial infarction using the 12‐lead ECG plus inverted leads versus the 16‐lead ECG (with additional posterior and right‐sided chest electrodes)

Trägårdh

Claesson

Wagner

et al. 2007

Clin Physio Funct Imaging

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“…Patients with acute RVMI have acute RV dysfunction that can improve gradually to become almost normal in time. [21][22][23] These issues limit the direct clinical applicability of the present study.…”

Section: Discussionmentioning

confidence: 93%

Right Ventricular Infarction Causes Heterogeneous Autonomic Denervation of the Viable Peri-infarct Area

Elvan

Zipes

1998

Circulation

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Background-Because efferent autonomic pathways to the right ventricle (RV) differ from the efferent autonomic projections to the left ventricle (LV), we assessed the effects of RV infarction on this innervation. Methods and Results-We measured the ventricular effective refractory period (ERP) shortening in response to bilateral ansae subclaviae stimulation and ERP lengthening induced by bilateral vagal stimulation as markers of autonomic innervation before and after RV myocardial infarction (RVMI) produced by coronary ligation (nϭ28 dogs) or intracoronary latex injection (nϭ18 dogs) into a marginal branch of the right coronary artery in open-chest anesthetized dogs. In each dog, ERPs measured in viable peri-infarct area at two RV outflow tract (RVOT) sites and two septal and four lateral sites at the RV free wall after RVMI showed reduced or absent ERP shortening during bilateral ansae subclaviae stimulation laterally, septally, and at RVOT sites 3 hours after RVMI. ERP shortening in response to infused norepinephrine was still present. Bilateral vagal stimulation during background norepinephrine infusion (0.10 to 0.25 g/kg per minute) lengthened the ERP at all test sites before latex injection. After transmural RVMI, vagally induced ERP prolongation was attenuated or lost at lateral, septal, and RVOT test sites. Conclusions-RVMI causes sympathetic and vagal denervation at viable sites at the RVOT, lateral, and, to a lesser extent, septal sides of the viable peri-infarct area. Autonomic denervation in the RVOT might contribute to the development of ventricular tachyarrhythmias after the acute stage of myocardial infarction involving the RV. (Circulation. 1998;97:484-492.)

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“…This sign is rarely seen more than 12 hours after the infarction. 16,17 As this lead is positioned on the right hemithorax, it might better monitor injury currents from the right side of the heart when compared with extremity lead III and may thereby reduce the amount of patients with an RCA occlusion and a 'false-negative' ECG algorithm due to similar ST elevation in leads II and III. When using lead V 4 R in inferior myocardial infarction, ST-segment de- viation in that lead does not last as long as in the standard extremity leads.…”

Section: Right Ventricular Myocardial Infarctionmentioning

confidence: 99%

Electrocardiographic localization of infarct related coronary artery in acute ST elevation myocardial infarction

Rajasekhar

Vanajakshamma

2013

JCSR

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Myocardium is usually supplied by three coronary arteries, although there are several variations in the number, origin, course and distribution of coronary arteries. Major contribution to left ventricular myocardial blood flow is by left anterior descending coronary artery (LAD) (50%), rest is equally contributed by right coronary artery (RCA) and left circumflex artery (LCx). In addition, most of the right ventricle is supplied by RCA. The need for a rapid reperfusion therapy is largely determined by how close the occlusion site is to the origin of the coronary artery, which corresponds to the area of ischaemic myocardium.Each artery contributes its blood supply to specific regional areas in the heart. These areas are topographically represented by the following groups of leads: 1 (Table 1). MYOCARDIAL DISTRIBUTION OF THREE MAIN CORONARY ARTERIES Left anterior descending arteryThe LAD travels along the anterior interventricular groove towards the apex of the heart. The major branches of LAD are septal and diagonal branches.The septal branches arise perpendicularly from the LAD and pass into the interventricular septum. The diagonal branches of the LAD course over the anterolateral aspect of the heart. Considerable variations exist in the number and size of the diagonal branches. In most (80%) patients, the LAD courses around the apex of the left ventricle and terminates along the diaphragmatic aspect of the left ventricle. In the remaining patients, the LAD terminates either at or before the cardiac apex. In these patients, the left ventricular apical portion is supplied by the posterior descending branch (PDA) of the RCA or LCx, which is larger and longer than usual. Left circumflex arteryThe LCx artery passes within the left atrioventricular groove toward the inferior interventricular groove. The LCx artery is the dominant vessel in 15% of patients, supplying the left PDA from the distal continuation of the LCx. In the remaining patients, the distal LCx varies in size and length, depending on the number of posterolateral branches supplied by the distal RCA. The major ABSTRACTThe electrocardiogram (ECG) remains a crucial tool in the identification and management of acute myocardial infarction (MI). A detailed analysis of patterns of ST-segment elevation may influence decisions regarding the use of reperfusion therapy. The early and accurate identification of the infarct-related artery on the ECG can help predict the amount of myocardium at risk and guide decisions regarding the urgency of revascularization. The specificity of the ECG in acute MI is limited by individual variations in coronary anatomy as well as by the presence of preexisting coronary artery disease, particularly in patients with a previous MI, collateral circulation, or previous coronary-artery bypass surgery. The ECG is also limited by its inadequate representation of the posterior, lateral, and apical walls of the left ventricle. Despite these limitations, the electrocardiogram can help in identifying proximal occlusion of the coronary arte...

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The early recognition of right ventricular infarction: diagnostic accuracy of the electrocardiographic V4R lead.

Cited by 200 publications

References 40 publications

Detection of acute myocardial infarction using the 12‐lead ECG plus inverted leads versus the 16‐lead ECG (with additional posterior and right‐sided chest electrodes)

Detection of acute myocardial infarction using the 12‐lead ECG plus inverted leads versus the 16‐lead ECG (with additional posterior and right‐sided chest electrodes)

Right Ventricular Infarction Causes Heterogeneous Autonomic Denervation of the Viable Peri-infarct Area

Electrocardiographic localization of infarct related coronary artery in acute ST elevation myocardial infarction

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