Right Ventricular Infarction

Report:

Accelerated junctional rhythm 95/min

SVEBs (two couplets)

Absolute small voltage

Acute inferior infarction

Right ventricular infarction

Comment:

The repolarisation changes are massive for the size of the remaining QRS complexes and the trace looks bizarre. There is no question, however, about acute inferior and anteroseptal ST segment elevation, with equally prominent reciprocal depression in the anterolateral leads.

While inferior and anteroseptal infarction can combine to produce this appearance, the precordial ST segment elevation is much more likely the consequence of right ventricular infarction. Sometimes it can involve all the anterior leads17. The entire picture suggests proximal RCA occlusion. Probably sudden – no collaterals or preconditioning.

The trace below (Fig 22a) is slower and contains several ventricular ectopic beats; it looks – and was – agonal. It is shown to demonstrate the resolution of precordial ST elevation except in V1. The ECG evidence of RV infarction tends to dissipate quickly; it would have gone from V1 as well had the patient lived longer.

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