Right Ventricular Infarction

Report:

Junctional rhythm 44/min

Acute inferior infarction

Right ventricular infarction

Comment:

The patient’s shock may well be due to a large infarction, but this is not, electrocardiographically, visible in inferior infarcts unless the reciprocal changes are extensive (Figs 8b and 8c), a 54 year old man also in shock). What can be seen is the absence of atrial contribution to the ventricular filling and, possibly, some atrial (?retrograde ?dissociated antegrade) activity after the QRSs. Also visible is ST segment elevation in V1 instead of the expected reciprocal depression, seen here in V2: sign of RV infarction. No need for V4R here.

The patient underwent an urgent PTCA, with resolution of ST segment abnormalities (Fig 8a). The R wave loss and evolving Q waves in the inferior leads are obvious.

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