ECG Quest > Ischemia > Basic STEMI localisation > Right ventricular MI

Right ventricular MI

Right ventricular infarction causes ST elevation in V1 (> V2, or with ST depression in V2), lead III > II and right sided leads V3R-V6R.

Right ventricular infarction is easily missed, so a high index of suspicion is needed in all patients with inferior MI.

See also: Basic STEMI localisation

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Anterior ST depression Inferior ST elevation Reciprocal ST depression Acute Inferior MI Acute Posterior MI Right ventricular MI 12-Lead ECG Guru CC-BY-NC-SA
Instructors’ Collection ECG: Inferior Wall M.I. With Atrial Fibrillation or Atrial Flutter

This ECG is from a man in his 70s who presented with chest pain. He had a history of COPD.

This ECG shows massive inferior ST elevation with widespread ST depression. The most likely cause was an acute inferior infarct.

In the ECGquest archives, this ECG has been tagged with: - Hyperacute T waves Inferior ST elevation Lateral ST elevation Acute Inferior MI Right ventricular MI 12-Lead Dr Smith's ECG Blog CC BY-NC
Inferolateral STEMI: is there right ventricular MI also?

This ECG is from a middle aged man who presented with 1 hour of chest pain.

This ECG shows ST elevation in inferior and lateral leads, caused by a proximal RCA occlusion.

In the ECGquest archives, this ECG has been tagged with: - Hyperacute T waves Inferior ST elevation ST elevation in V4R Acute Inferior MI Right ventricular MI Right leads Dr Smith's ECG Blog CC BY-NC
Inferolateral STEMI: is there right ventricular MI also? Right sided ECG

This ECG is from a middle aged man who presented with 1 hour of chest pain. This was a right sided ECG where V1-6 are really V1R to V6R.

This ECG shows ST elevation in inferior and right sided leads, caused by a proximal RCA occlusion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Peaked T waves ST elevation in V1 Right ventricular MI 12-Lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
The Interventionalist Refuses Angiography, and even to speak to the Emergency Physician

This ECG is from a middle aged patient who presented with chest pain of uncertain duration.

This ECG shows ST elevation in V1 only. This was dynamic on serial ECGs. The cause was a proximal RCA occlusion. The T waves were peaked but the potassium was normal.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Peaked T waves Right ventricular MI 12-Lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
The Interventionalist Refuses Angiography, and even to speak to the Emergency Physician – repeat ECG pain free

This ECG is from a middle aged patient who presented with chest pain of uncertain duration. This was the repeat ECG when pain free

This ECG shows ST elevation in V1 has resolved. This was dynamic on serial ECGs. The cause was a proximal RCA occlusion. The T waves were peaked but the potassium was normal.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Inferior ST elevation Peaked T waves Reciprocal ST depression ST elevation in V1 Right ventricular MI 12-Lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
The Interventionalist Refuses Angiography, and even to speak to the Emergency Physician – repeat ECG pain free

This ECG is from a middle aged patient who presented with chest pain of uncertain duration. This was the repeat ECG when pain returned.

This ECG shows ST elevation in V1, II, III and aVF with reciprocal ST depression in aVL. The cause was a proximal RCA occlusion. The T waves were peaked but the potassium was normal.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Inferior ST elevation Inverted T waves Lateral ST elevation Right ventricular MI 12-Lead Dr Smith's ECG Blog CC BY-NC
Is there a Right Ventricular MI in addition to Infero-postero-lateral MI?

This ECG is from a woman in her 40s who presented with sudden onset chest pain.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Excessive discordant ST elevation Pacemaker spikes ST elevation in V1 Wide QRS Acute Inferior MI Right ventricular MI 12-Lead Serial 12-lead Dr Smith's ECG Blog CC BY-NC
A 50-something with h/o coronary bypass has chest pain and a ventricular paced rhythm – 3, 16 min later

This ECG is from a man in his 50s who presented with chest pain on a background of previous CABG and dual chamber pacemaker. This was the repeat ECG 16 min after arrival.

This ECG shows a ventricular paced rhythm with excessive discordant ST elevation in III and aVF, and ST depression in aVL. The cause was an inferior and right ventricular infarction.