Diagnostic Value of Standard 12 Lead Electrocardiography in Acute RV Myocardial Infarction Research Center of Cardiology- Birjand University of Medical Science

Document Type : Research Paper

Authors

1 Associated professor of cardiology, Birjand university of Medical science, Birjand, Iran

2 Associated professor of cardiology, Mashhad University of Medical science Mashhad, Iran

3 Eneral practitioner, Birjand, Iran

Abstract

Introduction
Right ventricular infarction (RVMI) is associated with increased morbidity and mortality in patients with acute inferior myocardial infarction (MI). Although, electrocardiography is probably the most useful, simple, and objective tool for the diagnosis of acute MI, there are no well-defined criteria in the standard 12-lead electrocardiogram to properly identify RVMI in patients with acute inferior MI. The aim of this study was to evaluate the value of ST-segment changes in 12-lead in diagnosing RVMI in patients with acute inferior MI.
Materials and Methods
A total of One hundred sixty seven patients, hospitalized with acute inferior MI, were included in this study. The diagnosis of acute inferior MI was based on the clinical history and the appearance of ST-segment elevation (STE) ³1 mm in at least two of the leads (leads II, III, aVF). RVMI was defined by STE³1 mm in lead V4R during the first 12 hours after the beginning of the symptoms. Then the patients were divided into two groups (RVMI + and -) and ST-segment changes were compared between the two groups.
Results
The Ninety patients (51.1%) had RVMI according to lead V4R. ST-segment change ³1mm was seen in I, III, aVL, and in aVF; also ST-segment depression ³2mm in I+aVL and STE³1 mm in lead III greater than lead II (III>II) was significantly different between the two groups. The high sensitivity-specificity was seen in lead I: 86%-72%; lead aVL: 96%-26%; I+aVL: 84%-71%; and III>II: 82%-74%.
Conclusion
More than 1 mm ST-segment depression in lead I, STE in III>II and ST-segment depression³2 mm in I+aVL are possible to identify RVMI in patients with acute inferior MI.

Keywords

References

1- Hamon M, Agostini D, Le Page O, Riddell JW. Prognostic impact of right ventricular involvement in patients with acute
myocardial infarction: meta-analysis. Crit Care Med 2008; 36:2023-2033.
2- Mehta SR, Eikelboom JW, Natarajan MK, Diaz R, Yi C, Gibbons RJ, Yusuf S. Impact of right ventricular involvement on
mortality and morbidity in patients with inferior myocardial infarction. J Am Coll Cardiol 2001; 37:37-43.
3- Pereira AC, Franken RA, Sprovieri SR, Golin V. Impact on hospital mortality and morbidity of right ventricular
involvement among patients with acute left ventricular infarction. Sao Paulo Med J 2006; 124:186-191.
4- Saw J, Davies C, Fung A, Spinelli JJ, Jue J. Value of ST elevation in lead III greater than lead II in inferior wall acute
myocardial infarction for predicting in-hospital mortality and diagnosing right ventricular infarction. Am J Cardiol 2001;
87:448-450.
5- Zornoff LA, Skali H, Pfeffer MA, St John Sutton M, Rouleau JL, Lamas GA , et al. Right ventricular dysfunction and risk
of heart failure and mortality after myocardial infarction. J Am Coll Cardiol 2002; 39:1450-1455.
6- Carter T, Ellis K. Right-ventricular infarction. Crit Care Nurse 2005; 25:52-54, 56-58, 60-52.
7- Zehender M, Kasper W, Kauder E, Schö nthaler M, Geibel A, Olschewski M ,et al. Right ventricular infarction as an
independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328:981-988.
8- Navarro C, Owens C, Riddell J, McClelland A, Anderson JM, Escalona O, et al. The use of calculated epicardial
potentials improves significantly the sensitivity of a diagnostic algorithm in the detection of acute myocardial infarction. J
Electrocardiol 2003; 36:127-132.
9- Pahlm-Webb U, Pahlm O, Sadanandan S, Selvester RH, Wagner GS. A new method for using the direction of STsegment
deviation to localize the site of acute coronary occlusion: the 24-view standard electrocardiogram. Am J Med 2002;
113:75-78.
10- Lux RL, Kornreich F. Crossroads in electrocardiographic lead development: a roadmap to the future of
electrocardiographic leads in clinical electrocardiography. J Electrocardiol 2008; 41:183-186.
11- Zalenski RJ, Rydman RJ, Sloan EP, Hahn KH, Cooke D, Fagan J , et al. Value of posterior and right ventricular leads in
comparison to the standard 12-lead electrocardiogram in evaluation of ST-segment elevation in suspected acute myocardial
infarction. Am J Cardiol 1997; 79:1579-1585.
12- Hoffman I. Diagnosis of acute right ventricular infarction. J Electrocardiol 2009; 42:226-227.
13- Nair R, Glancy DL. ECG discrimination between right and left circumflex coronary arterial occlusion in patients with
acute inferior myocardial infarction: value of old criteria and use of lead aVR. Chest 2002; 122:134-139.
14- Moye S, Carney MF, Holstege C, Mattu A, Brady WJ. The electrocardiogram in right ventricular myocardial infarction.
Am J Emerg Med 2005; 23:793-799.
15- Cohn JN, Guiha NH, Broder MI, Limas CJ. Right ventricular infarction. Clinical and hemodynamic features. Am J
Cardiol 1974; 33:209-214.
16- Kinch JW, Ryan TJ. Right ventricular infarction. N Engl J Med 1994; 330:1211-1217.
17- Lopez-Sendon J, Coma-Canella I, Alcasena S, Seoane J, Gamallo C. Electrocardiographic findings in acute right
ventricular infarction: sensitivity and specificity of electrocardiographic alterations in right precordial leads V4R, V3R, V1,
V2, and V3. J Am Coll Cardiol 1985; 6:1273-1279.
18- Hsiao SH, Chiou KR, Huang WC, Cheng CC, Kuo FY, Lin KL, et al. Right ventricular infarction and tissue Doppler
imaging – insights from acute inferior myocardial infarction after primary coronary intervention. Circ J 2010; 74:2173-2180.
19- Jensen CJ, Jochims M, Hunold P, Sabin GV, Schlosser T, Bruder O. Right ventricular involvement in acute left
ventricular myocardial infarction: prognostic implications of MRI findings. AJR Am J Roentgenol 2010; 194:592-598.
20- Robalino BD, Whitlow PL, Underwood DA, Salcedo EE. Electrocardiographic manifestations of right ventricular
infarction. Am Heart J 1989; 118:138-144.
21- Tsuka Y, Sugiura T, Hatada K, Nakamura S, Yuasa F, Iwasaka T. Clinical significance of ST-segment elevation in lead
V1 in patients with acute inferior wall Q-wave myocardial infarction. Am Heart J 2001; 141:615-620.
22- Turhan H, Yilmaz MB, Yetkin E, Atak R, Biyikoglu SF, Senen K, et al. Diagnostic value of aVL derivation for right
ventricular involvement in patients with acute inferior myocardial infarction. Ann Noninvasive Electrocardiol 2003; 8:185-
188.
23- Somers MP, Brady WJ, Bateman DC, Mattu A, Perron AD. Additional electrocardiographic leads in the ED chest pain
patient: right ventricular and posterior leads. Am J Emerg Med 2003; 21:563-573.
24- Turkoglu S, Erden M, Ozdemir M. Isolated right ventricular infarction due to occlusion of the right ventricular branch in
the absence of percutaneous coronary intervention. Can J Cardiol 2008; 24:793-794.
25- Kukla P, Dudek D, Rakowski T, Dziewierz A, Mielecki W, Szczuka K, et al. Inferior wall myocardial infarction with or
without right ventricular involvement--treatment and in-hospital course. Kardiol Pol 2006; 64:583-8; discussion 589-90.
26- Shiraki H, Yokozuka H, Negishi K, Inoue S, Takahashi T, Chino M, et al. Acute impact of right ventricular infarction on
early hemodynamic course after inferior myocardial infarction. Circ J 2010; 74:148-155.
27-Ginghina C, Caloianu GA, Serban M, Dragomir D. Right ventricular myocardial infarction and pulmonary embolism
differential diagnosis – a challenge for the clinician. J Med Life 2010; 3:242-253. 
medical journal of mashhad university of medical sciences
Volume 54, Issue 3 - Serial Number 3
September and October 2010
Pages 159-165

Files

Share

How to cite

Statistics