Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ ECG Findings ++ Any ST elevation > 0.5 mm (0.05 mV) in right-sided leads (V1R-V6R). Simultaneous ST elevation in lead V1 with ST-depression in lead V2 strongly suggests right ventricular (RV) myocardial infarction (MI). Often associated with inferior MI and/or posterior MI. +++ Pearls ++ ECG changes of RV MI are subtle and easily missed. Obtain a right-sided ECG in any patient with inferior STEMI or in a patient with a significant hypotensive response to nitrates. A right-sided ECG is obtained by placing right-sided V leads, with V1-V6 in mirror-image locations on the right side of the chest. The ECG leads are then marked V1R-V6R. Alternatively, V1 and V2 leads can be placed in their usual position with leads V3-V6 placed in mirror image (then V3R-V6R). V4R is the most sensitive lead. The right ventricle is very preload dependent. As such, the administration of nitroglycerin or diuretics in the presence of acute RV infarction can precipitate profound hypotension. Avoid any preload-reducing medications in these patients and give fluids liberally to maintain blood pressure as long as the lungs remain clear. Treat hypotension in a patient with acute RV MI aggressively with fluids. ++ FIGURE 23.4A Right Ventricular Myocardial Infarction. This ECG was obtained with right-sided lead placement. (ECG contributor: Thomas Bottoni, MD.) Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt) ++ FIGURE 23.4B ST elevation in V4R and V5R (arrows), with the V4 and V5 leads placed in their mirror-image locations on the right side of the chest. Any ST elevation seen in the right-sided precordial leads is significant. Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt) GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessEmergency Medicine 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessEmergency Medicine Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options