This ECG was recorded from a 75-year-old man with substernal chest pain and diaphoresis. It shows a pretty classic picture of acute inferior wall M.I. The second ECG is a repeat tracing with the V4 wire moved to the V4 Right position, and it is positive for right ventricular M.I. The patient was found to have a 100% occlusion of the right coronary artery, which was opened and stented in the cath lab.
There are several other examples of IWMI with RVMI in our archives, so we will confine this commentary to the ECG signs that make these tracings so typical of right coronary artery occlusion. Once you are familiar with the typical pattern of IWMI / RVMI, it is easy to see, even when the ST elevation is subtle (as this one certainly is NOT).
Signs of IWMI in these ECGs are:
· ST elevation in inferior leads II, III and aVF.
· Reciprocal ST depression in leads I and aVL.
Signs of RVMI in these ECGs are:
· ST elevation in V4 right.
· ST elevation in V1 without ST elevation in V2.