CHF pt's

[CTXMEDIC]

And which leads look at the inferior wall? II, III, and aVF. V4 view the anterior heart, and closer to the lateral left ventricular wall more so than the inferior wall.

Im not sure I follow your point.

[chbare]

Point being, we are talking about V4 versus V4R . Big difference between these two leads. In addition, your article focuses on V4R and it's importance associated with the identification of RVI.

Take care,

chbare.

[CTXMEDIC]

Point being, we are talking about V4 versus V4R . Big difference between these two leads. In addition, your article focuses on V4R and it's importance associated with the identification of RVI.

Take care,

chbare.

Please, try to keep up with the class.

RVI can accompany left-sided inferior wall MI in as much as 40% of IWMI cases.

How is it that they found this out? By checking V4R? Or V4?

If you see elevation in II, III, aVf, youre 'hopefully' going to suspect a RVI and move V4 to V4R and confirm your suspicion. Which is what THIS paragraph is telling you:

To “screen” a patient for right-sided ventricular infarction with a 12-lead EKG calibrated machine you would reverse all of the left-sided leads to the right side of the chest. If you only had time to screen in one lead for RVI you would use V4R, since that lead looks directly at the right ventricle and is 90% specific and 90% sensitive. As you are getting close to the ED you check V4R by moving the Left V4 lead to the right side. Sure enough, ST segment elevation!

THIS sentance is telling you that :

RVI can accompany left-sided inferior wall MI in as much as 40% of IWMI cases.

Thanks for playing.

[chbare]

Uhhh, when we talk about inferior wall MI, we are in fact talking about the inferior wall of the left ventricle. Not exactly new knowledge brother. Assuming "normal" coronary artery anatomy: Right Coronary artery supplies the SA node, AV node, right ventricle, LEFT VENTRICULAR POSTERIOR WALL, and LEFT VENTRICULAR INFERIOR WALL. Obviously, the nodal arteries and the PDA among others branch off of the RCA. However, the whole "left" concept you keep bringing up is nothing new.

Take care,

chbare.

[CTXMEDIC]

never said it was 'new'. if you had read the whole post and the article, you too wouldnt need correcting. in fact what is being discussed is a RIGHT VENTRICULAR INFARCT, not an inferior infarct, not a left infarct.

all that is being said is that:

40% of the time a RIGHT VENTRICULAR INFARCT will be accompanied by a LEFT INFERIOR INFARCT ie. an ST elevation in lead V4. And that 60% of RIGHT VETRICULAR INFARCTS will have just elevation in 'r' leads and II, II and avF. Thats all, nothing more, nothing less.

Our original poster said that some doc had told him that a RVI will be accompanied by an s-t segment elevation in lead V4, 40% of the time. my article provided bears this out.

[p3medic]

Are you slow? V4 looks at the anterior wall of the left ventrical, not the inferior wall, not the right ventrical. The fact is, v4R, as in Right side, looks at the right ventrical. You will NOT see st elevation in V4 w/RVI, only V4R. Inferior MI presents with st elevation in II, III, avF, not v4. For someone who seems to be so sure of themselves you seem to know little about what you are trying to talk about. Perhaps you should sit back and watch a while junior... :evil:

[CTXMEDIC]

Are you slow? V4 looks at the anterior wall of the left ventrical, not the inferior wall, not the right ventrical. The fact is, v4R, as in Right side, looks at the right ventrical. You will NOT see st elevation in V4 w/RVI, only V4R. Inferior MI presents with st elevation in II, III, avF, not v4. For someone who seems to be so sure of themselves you seem to know little about what you are trying to talk about. Perhaps you should sit back and watch a while junior... :evil:

then be my guest and email the researches. tell them they are full of shit. a group of people with ALOT more education than you says that in 40% of RVI cases, you will see ST elevation in v4 as well.

V4 looks at the anterior wall of the left ventrical, not the inferior wall, not the right ventrical.

Yeah, we know. thats why its an interesting study.

Now run along kid and let the adults talk in peace.

[CTXMEDIC]

to break it down to your level. if you toss a 12 lead on someone and this patient is in the 40% group that the adults here are discussing, you will se elevation in V4, II, III and avF. and when you confirm an RVI you will see elevation in V4R as well. now beat it, im tired of providing you with a college education on the cheap.

[Camulos]

You will NOT see st elevation in V4 w/RVI, only V4R.

I see where you are going with your posts overall p3medic however this particular statement is unfortunately incorrect.

There are cases where isolated RVI has exhibited ST elevation in the precordial leads, including V4. Here’s one such case ;

Ilia R, Margulis G, Goldfarb B, Katz A, Rudnik L, Ovsyshcher IA: ST Elevation in Leads V1 to V4 caused by isolated right ventricular ischeamia and Infarction. Cardiology 1987;74:396-399

Having said that I must point out that elevation in lead V4, even accompanied by inferior ST elevation is USUALLY not specifically diagnostic for ISOLATED RVI. Notice I say USUALLY!!! After all the article above shows it can happen. In my experience though, the elevation in lead V4 more often than not suggests it is NOT an isolated RVI and highly raises the probability of left ventricular wall involvement.

So whilst elevation in lead V4 MAY be associated with isolated RVI I believe this is the exception rather than the rule. Elevation in lead V4R however certainly has much more of a higher probability for isolated RVI. Certainly if I were a betting man and had to lay a bet on which lead was more specific for a diagnosis of isolated RVI, I would go with V4R. Then again on the rare occasions I have placed a bet I usually lose my money. Perhaps there's a lesson there!!!

Stay safe,

Curse :evil:

[chbare]

Exactly, this is associated with isolated RVI; however, isolated RVI is in fact quite rare. In addition, all of this "left" and "40%" stuff seems to be taken out of context. Depending on your sources, around 1/3-1/2 of all patients experiencing inferior wall MI will also have RVI. This is what I gather from the article posted earlier as well. It only mentions 40% association with "left inferior wall MI." However, this concept seems to be taken out of context as many people associate inferior wall MI with the inferior wall of the left ventricle. So, we are in fact simply using little different terminology to describe the same problem. Inferior wall MI.

The first article is a general overview of RVI. While anomalies and additional research exists, the V4R is still highly sensitive and specific to RVI identification.

The second article focuses on the different characteristics of RVI. I would ask people to focus on the fourth paragraph under the discussion.

http://emedicine.medscape.com/article/157961-diagnosis

http://www.invasivecardiology.com/article/2975

Take care,

chbare.