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Up to 1/3 of inferior STEMIs will extend to the right ventricle (RV).
It is important to distinguish RV MI clinically as it may change management (use of nitrates, IV fluids, etc.)
Always consider RV MI when dealing with inferior STEMIs and consider getting right sided leads when you pick up any of the following ECG findings:
Leads aVR or V1 may exhibit ST elevation ≥ 1.0 mm. ST depression may also be seen in V2 with ST elevation or isoelectric ST segments in V1
Record right precordial leads (V3R and V4R), ST elevation ≥ 0.5 mm (≥ 1.0 mm in men <30 years old) is diagnostic
Changes may be transient, and absence of ECG changes in leads V3R and V4R does not exclude RV infarction
KEY PEARL:
KEY PEARL:
In both men (≥ 30 years old) and women (all ages), STE in V3R & V4R ≥ 0.5 mm meets the classic STEMI criteria. In young men < 30 years old, ≥ 1.0 mm is required.
Reference:
Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol 2018;72(18):2231–64. PMID: 30153967
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