1. AN INTERESTING ECG DEPARTMENT OF CARDIOLOGY, GRH, MADURAI

4. 50 years old, male,has presented with retrosternal chest pain. Diagnosed to have CAD / Acute inferior wall infarction with posterior wall and RV extension. Not a known DM / HT. No previous h/o similar chest pain. Chronic smoker. Thrombolysed with Inj.Streptokinase.

5. ECG signs of RVMI In the clinical setting of acute IWMI, there is ST elevation of 1mm or more in lead V4R or any one of the extra right precordial leads, V4R to V6R. Lead V4R is most sensitive.An ST segment which is higher in lead V4R than in leads V1 to V3 offers the highest specificity and efficiency in diagnosis. ST depression in V2 which is 50%(or less) the magnitude of the ST segment elevation in lead avf indicates RV ischemic injury. It also indicates occlusion of RCA proximal to RV branch.

6. ST elevation in lead V1, as well as other precordial leads V2 to V5. The magnitude ST elevation in leads V1 to V5 decreases from right to left, the ST elevation being maximal in V1. Abnormal Q waves do not manifest in these leads. The ST elevation in V1 with ST depression in V2 – a discordant relationship suggests the prescence of RVMI. Lewes and associates reported the hyperacute phase of RVMI. This manifests with slope elevation of ST segment in V1 and V4R.

7. Another criterion used is to compare the ST elevation of V4R to V3. It is seen that in RVMI the ST elevation in V4R is more than the ST elevation in V3.