Right Sided MI - How Do I Tell The Difference

[kevkei]

Thats a very specific staement.

Do you have a reference?

Not that I disagree...just want to be "solid"....

Specific reference, had to search to find my textbook...

- The 12-Lead ECG In Acute Myocardial Infarction, Tim Phalen pp 42. Mosby Lifeline ISBN 0-8151-6752-0

Supporting reference

- ECG's Made Easy, Second Edition, Barbara Aehlert pp 213. Mosby ISBN 0-323-01432-1

- Sensitivity 70-93%, sensitivity 77-100% ( Chou, T, Knilans TK: Electrocardiography in clinical practice: adult and pediatric, Philadelphia, WB Saunders)

J Lopez-Sendon, I Coma-Canella, S Alcasena, J Seoane, and C Gamallo

To clarify, 40% of inferior MI's involve the right ventricle, but >95% of RVI have inferior involvement. DocHarris, we're saying the same thing.

[croaker260]

Specific reference, had to search to find my textbook...

- The 12-Lead ECG In Acute Myocardial Infarction, Tim Phalen pp 42. Mosby Lifeline ISBN 0-8151-6752-0

Supporting reference

- ECG's Made Easy, Second Edition, Barbara Aehlert pp 213. Mosby ISBN 0-323-01432-1

- Sensitivity 70-93%, sensitivity 77-100% ( Chou, T, Knilans TK: Electrocardiography in clinical practice: adult and pediatric, Philadelphia, WB Saunders)

J Lopez-Sendon, I Coma-Canella, S Alcasena, J Seoane, and C Gamallo

To clarify, 40% of inferior MI's involve the right ventricle, but >95% of RVI have inferior involvement. DocHarris, we're saying the same thing.

Well done. Thanks.

[FL_Medic]

This is a RVI from a call I ran personally. Try clicking it to zoom.

[kevkei]

FL_Medic thanks for posting this,

that strip is a good example of where V8,V9 posterior leads would be nice to see. You see T wave inversion in V1 and V1 as well as ST depression in V2. I'd be highly suspicious of posterior involvement.

What is the point? It has evovled from an inferior STEMI to Inerior, posterior and right ventricular infarct. Probably a proximal occlusion of the RCA. These patients have a high mortality rate, respond very poorly to SL nitrates (IV drip only) and an example of why EMT's giving nitro, nitro without a 12 lead and IV are all bad things. Also an example of treating the monitor and not the patient. Yes these patients are few, but these are the ones we can kill if treated improperly.

[chbare]

Another example of one I flew a couple of years ago:

Take care,

chbare.

[FL_Medic]

FL_Medic thanks for posting this,

that strip is a good example of where V8,V9 posterior leads would be nice to see. You see T wave inversion in V1 and V1 as well as ST depression in V2. I'd be highly suspicious of posterior involvement.

What is the point? It has evovled from an inferior STEMI to Inerior, posterior and right ventricular infarct. Probably a proximal occlusion of the RCA. These patients have a high mortality rate, respond very poorly to SL nitrates (IV drip only) and an example of why EMT's giving nitro, nitro without a 12 lead and IV are all bad things. Also an example of treating the monitor and not the patient. Yes these patients are few, but these are the ones we can kill if treated improperly.

What's the point? With v1 & v2 the way they are, you already know there is posterior involvement. I guess, if time allowed, changing up the leads wouldn't hurt.

[zzyzx]

My understand is inferior + right-ventricular MI's actually do quite well with treatment because the R ventricle is more likely to recover from ischemia. An MI that causes cardiogenic shocks obviously has a high mortality rate, but not so when the hypotension is due to the R ventricle being involved. The myocardium is "stunned" from the ischemia, but it is less likely to infarct.

I'm not sure if this has already been said, but besides the classic triad of hypotension, clear lungs, and JVD, other signs that are suggestive of an MI with R-ventricular involvement are bradycardia, AV block, and new-onset AF.

A few months ago I had a patient with all the above signs (except no block). Unfortunately, my service still does not have 12-leads, otherwise I would be able to share an interesting strip with you.

[chbare]

If I read the prior threads correctly, I think people were saying the presence of a posterior wall MI leads to increased morbidity and mortality. Actually, I think there is increased overall morbidity and mortality with RVI simply because more of the heart is involved.

Take care,

chbare.

[FL_Medic]

If I read the prior threads correctly, I think people were saying the presence of a posterior wall MI leads to increased morbidity and mortality. Actually, I think there is increased overall morbidity and mortality with RVI simply because more of the heart is involved.

Take care,

chbare.

Would make sense. Morbidity and mortality associated with AMI has two do mostly with one of the two following reasons:

- Time

- Where the clot is located

Of coarse there are other factors like age, and medical Hx, but these are the biggest. Time is what you are talking about. If the area of infarction is in a sense growing from the inferior wall, and reaches the RV and posterior wall you would, in turn, have greater morbidity. The clot location is a pretty big one as well, we've all heard about the "widow-maker" (LAD) occlusions.

[kevkei]

What's the point? With v1 & v2 the way they are, you already know there is posterior involvement. I guess, if time allowed, changing up the leads wouldn't hurt.

If you don't look, how do you know there is with certainty? Or if V1 and V2 appear normal, how do you know V8 and V9 are clear? Not all injury presents with reciprocal changes. (Playing Devil's advocate). I understand if it talks like a duck, it's probably a duck.