0071643192.pdf

CARDIOVASCULAR EMERGENCIES

TABLE 2.2. Regional ECG Findings in the Setting of MI

REGION OF

REGION OFST ELEVATION INFARCT AFFECTEDVESSEL SPECIALCONSIDERATIONS

II, III, aVF Inferior Right coronary Anticipate RV or

Reciprocal changes in aVL artery—posterior posterior infarct.

descending branch

V 3 , V 4 Anterior Left anterior Anticipate BBB, LV

Reciprocal changes in descending— dysfunction, complete

II, III, aVF diagonal branch heart block.

V 1 , V 2 Septal Left anterior Anticipate BBB.

descending—septal

branch

V 5 , V 6 , and I, aVL Lateral Left circumflex— Anticipate LV

circumflex or dysfunction with CHF.

diagonal branch

OnR-sided ECG: V 4 R Right Right coronary Anticipate hypotension

(See Figure 2.11.) ventricle artery—proximal with clear lungs.

branches Preload dependent.

Posterior ECG: Posterior Left circumflex— Rarely occurs in

precordial leads posterior circumflex isolation, usually with

Anterior ECG:ST depression or inferior or lateral MI

in V 1 , V 2 with prominent right coronary Anticipate LV

R waves; tall, upright T wave artery—posterior dysfunction.

in V 1 instead of normally descending

inverted T wave; helpful to

obtain additional posterior

ECG leads V 8 and V 9

FIGURE 2.11. Right-sided ECG in patient with inferior MI.

(Reproduced, with permission, from Fuster V, Alexander RW, O’Rourke, RA. Hurst’s The

Heart, 12th ed. New York: McGraw-Hill, 2008:300.)

Always get an R-sided ECG to

look for RV infarct in inferior

wall MI.

Patients with RV infarct are

preload dependent.

ST depression in V 1 , V 2 with

prominent R waves? Suspect

posterior MI!