|This is part of: Myocardial Infarction|
ST elevation in II, III and aVF
This part of the heart muscle lies on the diaphragm and is supplied of blood bij the right coronary artery (RCA) in 80% of patients. In the remaing 20% the inferior wall is supplied by the ramus circumflexus(RCX).
An occlusion of the RCA can be distinguished of a RCX occulusion on the ECG:
- Distal RCA occlusion (sens 90%, spec 71%)
- ST segment elevation in III higher than ST segment elevation in II ("the highest elevation points at the culprit")and
- ST segment depression in I, AVL, or both (>1 mm)
- Proximal RCA occlusion (sens 79%, spec 100%)
- Additional ST segment elevation in V1, V4R or both
- RCX occlusion (sens 83%, spec 96%)
- ST segment elevation in I, AVL, V5, and V6 and
- ST segment depression in V1, V2, and V3
- Zimetbaum PJ and Josephson ME. Use of the electrocardiogram in acute myocardial infarction. N Engl J Med 2003 Mar 6; 348(10) 933-40. doi:10.1056/NEJMra022700 pmid:12621138.