Inferior MI

From ECGpedia
Jump to navigation Jump to search
The printable version is no longer supported and may have rendering errors. Please update your browser bookmarks and please use the default browser print function instead.
This is part of: Myocardial Infarction

ST elevation in II, III and aVF

ST elevation or depression in V4R can help in differentiating a RCA from a RCX occlusion.

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:[1]

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


Examples

References

  1. 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 | PubMed ID:12621138 | HubMed [Zimetbaum]