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Case 2: 63-year old woman presented with central chest pain of two hours duration. On examination her blood pressure was 90/60 mm Hg, she had a weak pulse, distended neck veins with elevated jugular venous pressure, normal first and second heart sounds and lung fields were clear on auscultation. |
Ragavendra
R. Baliga, M.D
Assistant
Professor
Division
of Cardiology
University
Of Michigan
Question 2 of 17:
Right precordial leads, in particular lead V4R, should be recorded in this patient at the time of admission.
You clicked 'True'
Correct!
The evidence of right ventricular ischemia should be sought in all patients with acute inferior MI at the time of admission. Rt precordial leads, in particular lead V4R must be recorded in all patients with inferior MI.
1-mm ST segment elevation in the right precordial lead V4R is the single most predictive ECG finding in patients with right ventricular ischemia (1). This finding, however, may be transient; half of the patients show resolution of ST elevation within 10 hours of the onset of symptoms (2).
The ACC/AHA committee on the management of acute myocardial infarction recommends that hospital personnel (house officer, nurse or technician) recording the ECG show know how to properly record lead V4R. Also all critical care staff should be encouraged to choose monitoring leads depending on the site of infarction.
Reference:
1. Robalini BD, Whitlow PL, Underwood DA, Salcedo EE. Electrocardiographic manifestations of right ventricular infarction. Am Heart J 1989;118:138-144
2. Braat SH, Bruguda P, DeZwaan C, Coenegracht JM, Wellens HJ. Value of electrocardiogram in diagnosing right ventricular involvement in patients with an acute inferior wall myocardial infarction. Br Heart J 1983;49:368-372.
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