Can right ventricular infarction be determined on the ECG?

Myocardial infarction involving the right ventricular wall is rarely isolated. It has been found with equal frequency in both anterior and inferior infarction. Because the right ventricular muscle mass is small in comparison to the left ventricle, the ECG diagnosis depends on the finding of acute inferior or inferoposterior myocardial infarction plus ST-segment elevation of 1 mm or more of the right precordial leads. Of significant help is the finding of ST-segment elevation in leads V3R and V4R. Thus, in patients with inferior infarcts, these leads should be included with the standard 12-lead ECG. When anterior infarction is present, the diagnosis of right ventricular infarction is difficult. Right ventricular infarction can clinically mimic severe left heart failure, and because present treatment for the two conditions is quite different, the importance of proper diagnosis is evident.

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