Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

ConclusionAmong inferior STEMI, the presence of any ST depression in lead I does not help to diagnose RVMI. ST elevation ≥0.5 mm in lead V1 is specific for RVMI, and moderately sensitive only if concomitant STD ≥ 0.5 mm in V2 is not present. Although STE in V1 is quite specific, overall the diagnostic characteristics of the standard 12‑lead ECG are inadequate to definitively diagnose, or exclude, RVMI, a s defined angiographically.____________________________Kosuge M, Ishikawa T, Morita S, Ebina T, Hibi K, Maejima N, Umemura S, Kimura K.Posterior wall involvement attenuates predictive value of ST-segment elevation in lead V4R for right ventricular involvement in inferior acute myocardial infarction.J Cardiol [Internet]. 2009;54:386 –393. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19944313BACKGROUND: ST-segment elevation of>/=1.0 mm in the right precordial chest lead V4R (ST upward arrowV4R) has been shown to be a reliable marker of right ventricular involvement (RVI) in inferior acute myocardial infarction (IMI). However, the impact of left ventricular posterior wall involvement (PWI) on the relation between ST upward arrowV4R and RVI is unknown. METHODS: We studied 267 patients with recanalized IMI due to the right coronary artery (RCA) occlusion within 6h after symptom onset. A 12-lead electrocardiogram, lead V4R, and leads V7-9 were recorded on admission. RV...
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