Correct side in AMI smoothly

Aug 6th, 2022
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How to Correct side in AMI

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a patient presents to your emergency department complaining of chest pain he is a 52 year old male with a history of hypertension diabetes and hypercholesterolemia he reports abrupt onset crushing pain to his mid chest radiating into his left shoulder he also reports shortness of breath dizziness nausea and vomiting his vital signs are pulse 90 blood pressure 160 over 80 you suspect he is having an mi so you obtain an EKG since you already watched the lecture on identifying stem ease you correctly interpret this EKG as an inferior wall ST elevation mi you give the patient nitroglycerin to try to dilate his coronary arteries and relieve his pain shortly thereafter the patient becomes pale and diaphoretic his repeat blood pressure is 80 over 50 what happened the answer is a right ventricular mi inferior wall mi s are sometimes associated with infarction of the right ventricular wall as well lets take a look at right ventricular Mis and lets see if we can get a better understanding of w

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Approximately 40% of inferior wall infarctions also involve the right ventricle. Right ventricular infarctions are very pre-load dependent, and nitrates may precipitate a drop in blood pressure. The addition of right-sided ECGs leads, especially lead V4r, will aid in that diagnosis.
Approximately 40% of inferior wall infarctions also involve the right ventricle. Right ventricular infarctions are very pre-load dependent, and nitrates may precipitate a drop in blood pressure. The addition of right-sided ECGs leads, especially lead V4r, will aid in that diagnosis.
More often, right ventricular MI (RVMI) is associated with acute ST-elevation MI of the inferior wall of the left ventricle and occurs in 30 to 50 percent of such cases [1-6].
Myocardial infarction occurs when blood flow to a part of the heart diminishes or stops altogether, causing irreversible damage to the heart muscles. Acute myocardial infarction involving only the right ventricle is a much less common condition than left ventricular infarction.
Right-sided leads The most useful lead is V4R, which is obtained by placing the V4 electrode in the 5th right intercostal space in the mid-clavicular line. ST elevation in V4R has a sensitivity of 88%, specificity of 78% and diagnostic accuracy of 83% in the diagnosis of RV MI.
A right-sided 12-lead ECG is obtained. To accomplish this, the EMS crew places the precordial leads in the mirror-image position on the right side of the patients chest. Editors note: Sometimes leads V1 and V2 are left in place and only leads V3-V6 are moved over to mirror image position on the patients right side.
ing to the ESC (2017), the right precordial leads V3R and V4R should be used regularly for patients displaying inferior MI. In lead V4R, an ST-segment elevation -1 mm is considered a highly sensitive and reliable marker for RVMI with 100% sensitivity, 92% accuracy and 87% specificity (Somers et al, 2003).
12-lead electrocardiogram (ECG) demonstrating evidence of inferior myocardial infarction (MI). ST-elevation is seen in leads II, III and aVF. Reciprocal changes can be seen in leads I, aVL, V2 and V3. There is also some ST-elevation in leads V5 and V6.

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