Inferolateral STEMI: is there right ventricular MI also?

A middle-aged patient called 911 for 1 hour of chest pain.He was hemodynamically stable.Here is the prehospital ECG:Obvious inferior MI, but also with STE in V3-V6Here is the first ED ECG:Again, inferior and lateral STEMI.Is there any right ventricular (RV) MI?85% of inferior MI are due to RCA occlusion.  Even the majority of inferolateral MI are due to RCA occlusion. The RCA may have a large lateral branch.RV MI is caused by RCA occlusion proximal to the RV marginal branch, especially when there are no collaterals from the LAD to the RV.We showed that, if there is zero ST depression in lead V2, that lead V1 is 85% sensitive for RVMI.  When there is STD in V2, only 35% have any STE in V1.In Inferior Myocardial Infarction, neither ST elevation in lead V1 nor ST depression in lead I are reliable findings for the diagnosis of right ventricular infarction.We should have titled it: In Inferior Myocardial Infarction, for diagnosis of RV MI, ST elevation in lead V1 is only sensitive in the absence of ST depression in V2; lead I is not reliable.We care about RV MI because it can cause RV failure, with shock and hypotension.But only a minority of patients with RV MI have these adverse hemodynamics, and an even smaller number with proximal RCA occlusion have these hemodynamics because they may have blood supply from LAD collaterals.Is it important to diagnose RV MI here?Probably not so much.  He is hemodynamically stable.Nevertheless, we took a look with a right sid...

Source: Dr. Smith's ECG Blog - January 16, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs