ECG Guru - Instructor Resources - V4 Right https://www.ecgguru.com/ecg/v4-right en V4 Right Lead Placement Illustration https://www.ecgguru.com/heart-illustrations/v4-right-lead-placement-illustration <div class="field field-name-field-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="https://www.ecgguru.com/sites/default/files/ecg-heart-art/V4Right%201.jpg"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/styles/medium/public/ecg-heart-art/V4Right%201.jpg?itok=xFrcjvft" width="196" height="220" alt="V4 Right Illustration" title="V4 Right" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>This is an original illustration by Dawn Altman.&nbsp; For commercial use, please contact Dawn at <a href="mailto:Dawn.ECGGuru@gmail.com">Dawn.ECGGuru@gmail.com</a>.&nbsp;</p></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/illustration-v4right-placement" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Illustration V4Right Placement</a></div><div class="field-item odd"><a href="/ecg/v4-right" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">V4 Right</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fheart-illustrations%2Fv4-right-lead-placement-illustration&amp;title=V4%20Right%20Lead%20Placement%20Illustration"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Sat, 22 Aug 2020 22:50:30 +0000 Dawn 790 at https://www.ecgguru.com https://www.ecgguru.com/heart-illustrations/v4-right-lead-placement-illustration#comments Inferior Wall M.I. With Right Ventricular M.I. https://www.ecgguru.com/ecg/inferior-wall-mi-right-ventricular-mi-0 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/inferior-wall-mi-right-ventricular-mi-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/IWR102.jpg" width="1800" height="689" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This week's ECG of the Week is from an elderly woman who suffered an acute occlusion of the right coronary artery.&nbsp; The ECG clearly shows ST elevation in leads II, III, and aVF, indicating inferior wall injury.&nbsp; In this case, this ECG was obtained in the field by paramedics, and was the second ECG done on this patient. For this tracing, the paramedics obtained V3 and V4 on the right side to better view the right ventricle. V3 and V4 right clearly show ST elevation as well, indicating RVMI.&nbsp; The slight coving and elevation observable in V1 is also an indication of RV involvement, and the ST depression in V2 indicates posterior wall injury.&nbsp; All of this results from a proximal lesion of the RCA in this patient.&nbsp; Such a lesion carries a high morbidity and mortality.</p><p>Taking the time to obtain a right ventricular lead is controversial in some settings.&nbsp; Some believe the patient's hemodynamic condition should be treated, regardless of the presence or absence of ST elevation in right chest leads.&nbsp; Others find it very helpful to know that the right ventricle is affected.&nbsp; In this case, paramedics in this community have a protocol to avoid the use of nitroglycerine in RVMI patients, even when the BP is adequate.&nbsp; So, for them, it is important to have the information gathered from V Right leads.</p><p>The rhythm here is interesting, as well, and not at all uncommon for IWMI patients.&nbsp; The baseline artifact makes it a bit difficult to march out all the P waves, but it appears they are sinus P waves that are slightly irregular at a rate of 52 to 54.&nbsp; The PR intervals appear to be progressively prolonging, but there is no "grouped beating" observable on this short strip.&nbsp; A lack of a concurrent Lead II rhythm strip also makes it difficult to determine the rhythm, as Lead II does have very visible P waves, and would be helpful.&nbsp; The regularity of the narrow complex bradycardia points to a junctional escape rhythm, which would make this a third-degree AVB at the AV node level, which is very common with IWMI.&nbsp; What do you think?</p><p>This month's strip from Jason Roediger's ECG Challenge blogpost is a nice complement to the strip presented here.&nbsp; His is much clearer, and has a Lead II rhythm strip.&nbsp; Do you think these ECGs show the same rhythm, or two different rhythms?</p><p>For an excellent discussion of "AV Dissociation" vs. "AV Block", go to Christopher Watford's <a href="http://www.ekgguru.com/content/how-do-you-explain-difference-between-av-block-and-av-dissociation-your-students">Ask the Expert </a>post.&nbsp; Thanks very much to ECG Guru Sebastian Garay for this interesting ECG.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/259/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Inferior Wall M.I. With Right Ventricular M.I. 1/5</option><option value="40">Give Inferior Wall M.I. With Right Ventricular M.I. 2/5</option><option value="60">Give Inferior Wall M.I. With Right Ventricular M.I. 3/5</option><option value="80" selected="selected">Give Inferior Wall M.I. With Right Ventricular M.I. 4/5</option><option value="100">Give Inferior Wall M.I. With Right Ventricular M.I. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.5</span></span> <span class="total-votes">(<span >2</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-et5R5xljo6WEXQ9ACdFPrglhbe55o2ZjU34nkbUyM-M" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/inferior-wall-mi-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Inferior Wall M.I.</a></div><div class="field-item odd"><a href="/ecg/right-ventricular-mi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right ventricular M.I.</a></div><div class="field-item even"><a href="/ecg/v4-right" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">V4 Right</a></div><div class="field-item odd"><a href="/ecg/stemi" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">STEMI</a></div><div class="field-item even"><a href="/ecg/av-dissociation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AV dissociation</a></div><div class="field-item odd"><a href="/ecg/av-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AV Block</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Finferior-wall-mi-right-ventricular-mi-0&amp;title=Inferior%20Wall%20M.I.%20With%20Right%20Ventricular%20M.I."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 13 Jan 2013 02:49:24 +0000 Dawn 391 at https://www.ecgguru.com https://www.ecgguru.com/ecg/inferior-wall-mi-right-ventricular-mi-0#comments