Anatomy - Right ventricular infarction

The RCA supplies blood to the right ventricle via the acute marginal (AM) branch (also known as the RV-branch). An occlusion in the proximal RCA would cut off this blood supply which in turn would lead to a right ventricular infarction. A standard 12 lead ECG is insufficient to record the activity of the right ventricle. For this purpose, a special lead called V4R can be used. Lead V4R is placed at the 5th intercostal space along the right midclavicular line, mirroring the placement of V4. All precordial leads except leads V1 and V2 have “mirror leads” which can be used to monitor right ventricular activity.

In proximal RCA occlusion and right ventricular infarction, ST elevation appears in lead V4R. ST deviations in V4R tend to disappear quickly due to the relative thinness of the right ventricular wall.

Isolated right ventricular infarct

The right ventricle lies anterior to the left ventricle. For this reason, an isolated right ventricular infarction also presents with ST elevation in the anterior leads and may be misdiagnosed as a left ventricular anterior wall infarction. However, in contrast to a left ventricular anterior wall infarction, an isolated right ventricular infarction presents with ST elevation in lead V4R.

 

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