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Arrhythmia Recognition Webcast Series
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Practice ECG 29
This ECG shows sinus bradycardia with diffuse ST segment changes. When we start looking at the ST segments in detail, we see that they are elevated in II, III, aVF, and V3 to V6. This is the inferolateral distribution mentioned in the previous ECG, and this patient is having an inferolateral AMI. Is there any evidence for RV infarct? No, the ST segments in leads I and III are about the same, and there is no elevation in V1. Should you obtain right-sided leads anyway? Yes! Make it a habit to obtain right-sided leads in any patient with an IWMI.
Is there any evidence of posterior wall involvement? No. Should you obtain posterior leads? It's up to you. Because the treatment for IWMI and PWMI are essentially the same, you don't need to go out of your way to prove the presence of the PWMI. It is important to know, however, that a combination inferoposterior AMI involves more myocardium than just an isolated AMI in either region. Why do we make such an issue about obtaining right-sided leads then? The treatment for an RV infarct is different, and this could lead to different treatment options for the two cases.
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