Which ST-segment elevation pattern suggests a right ventricular MI?

Which ST-segment elevation pattern suggests a right ventricular MI?

• A. ST elevation in leads I and aVL
• B. ST elevation in leads II and III
• C. ST depression in V5-V6
• D. T-wave inversion in aVR

Answer: (D)

Right ventricular infarction is suggested on the ECG by ST-segment elevation in the right-sided chest leads, especially V4R, and it may accompany an inferior-wall MI. This reflects involvement of the thin-walled right ventricle, which sits on the right side of the heart. Because the RV is preload-dependent, recognizing RV MI is crucial for management: avoid nitrates and diuretics initially, and give IV fluids to support preload while you obtain right-sided leads to confirm RV involvement. In the patterns shown, there isn’t a clear ST elevation in the right-sided leads, which is why these examples aren’t definitive for RV MI. T-wave inversion in aVR can indicate diffuse ischemia or left main disease rather than an isolated RV infarct. If RV MI is suspected, a right-sided ECG (placing leads on the right chest) is the key confirmatory step.

Right ventricular infarction is suggested on the ECG by ST-segment elevation in the right-sided chest leads, especially V4R, and it may accompany an inferior-wall MI. This reflects involvement of the thin-walled right ventricle, which sits on the right side of the heart. Because the RV is preload-dependent, recognizing RV MI is crucial for management: avoid nitrates and diuretics initially, and give IV fluids to support preload while you obtain right-sided leads to confirm RV involvement.

In the patterns shown, there isn’t a clear ST elevation in the right-sided leads, which is why these examples aren’t definitive for RV MI. T-wave inversion in aVR can indicate diffuse ischemia or left main disease rather than an isolated RV infarct. If RV MI is suspected, a right-sided ECG (placing leads on the right chest) is the key confirmatory step.