Thread by @ManualOMedicine

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💠 Remember to Obtain a Rightsided ECG in a Patient with an Inferior MI

➡️ Inferior MI typically causes ST Elevation in leads II,III,aVF and ST Depression or T-wave inversion (TWI) in lead I,aVL.

-- Read More: manualofmedicine.com/topics/cardiol…

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➡️ STD or a new TWI in lead aVL is often the first ECG abnormality seen in Inferior MI.

➡️ When an inferior MI is diagnosed, a right-sided ECG should be obtained to exclude concomitant right ventricular MI (RVMI). RVMIs can complicate 30% to 50% of acute IMIs.

#cardiology

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➡️ A right-sided ECG is performed by taking leads V3-V6 and placing them on the right side of the chest. These leads are labeled V3R-V6R.

➡️ STE of 0.5 mm or greater in one or more of leads V4R-V6R has a sensitivity of 90% and specificity of 91% for RVMI.

#cardiotwitter

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➡️ STE is more commonly seen in lead V4R compared with leads V5R and V6R

➡️ STE greater than 1 mm in lead V4R suggests a proximal occlusion of the right coronary artery (RCA) and an increased risk for AV block.

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➡️ Additional ECG findings that suggest an RVMI include:

👉 STE in lead V1
👉 STE in lead III that is greater than the STE in lead II
👉 Isoelectric ST segment in lead V1 with STD in lead V2

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➡️ It is important to diagnose an RVMI because it affects patient management.

➡️ Patients with an RVMI are preload dependent and require intravenous fluids to maintain adequate perfusion.

➡️ Avoid Nitrates and any medication that may decrease preload.

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