Right precordial leads

May manifest as tall R waves in the right precordial leads and ST-segment depression in leads Vj - V4... 

Obtain right precordial leads in any patient with an inferior wall myocardial infarction... 

Fujiki A, Usui M, Nagasawa H, Mizumaki K, Hayashi H, Inoue H. ST segment elevation in the right precordial leads induced with class IC antiarrhythmic drugs insight into the mechanism of Brugada syndrome. J Cardiovasc Electrophysiol 1999 10(2) 214-18. 

Figures 3.18 and 3.19 show the evolution of two Mis from the acute phase with a huge ST-segment elevation until the appearance of Q wave of necrosis and negative T wave of subepicardial ischaemia. In Figure 3.20, a patient with chronic MI of inferior wall presents in the same ECG a different grade of ECG pattern of subepicardial ischaemia (negative and deep T wave in inferior leads, tall and positive T wave in right precordial leads as a mirror pattern and flat T wave in V6).

Figure 4.3 Observe how an amplified ECG (4x) allows the proper assessment of ST-segment deviation. (A) Post-myocardial-infarction patient with slight ST-segment elevation in right precordial leads. When amplified ECG...

Figure 4.32 Usefulness of the ST/T changes in the extreme right precordial leads (V4R) to differentiate among the proximal RCA (A), distal RCA (B) and LCX involvement (C).

Figure 4.36 (A) Typical ECG in case of STE-ACS due to occlusion of very dominant RCA distal to RV branches. Observe the ST-segment elevation in inferior leads (III > II) and ST-segment depression the ST-segment depression in V1-V3 (occlusion distal to the take-off of RV branches). Furthermore, the ST-segment elevation in V6 is greater than 2 mm (occlusion of very dominant RCA). In extreme right precordial leads the ST is isoelectric in V3R and...

The presence of ST-segment elevation in the right precordial leads (V1-V3) and ST-segment depression in the left-sided leads (aVL, I and V4—... 

Figure 8.7 A 45-year-old patient with an acute precordial pain who presents a tall T and peaked T wave that follows a rectified ST segment in right precordial leads as the only ECG sign suggestive of ischaemia (A). Some minutes later ST-segment elevation appears (B) and very soon becomes very evident, accompanied by R-wave increase and S-wave decrease (C). The ECG pattern recorded in (C) presents...

Occasionally, the first change observed in an anteroseptal infarction, even extensive, is the increase in the T-wave amplitude in the right precordial leads, due to the acute subendocardium ischaemia in a heart without much prior ischaemia. This T-wave morphology may be interpreted as pseudonormal, and it should be readily recognised and differentiated from the normal T wave. In this case the recording of evolutionary ECG is mandatory (Figure 8.7). 

Striking final slurrings in II, III, VF, VL and right precordial leads (V2-V3). The Q wave in inferior leads and the r wave in V1 are narrow, and additionally the R/S ratio <0.5. This is an evident case of Ml presented by striking final slurrings of QRS. 

These repolarisation changes in the extreme right precordial leads are seen only in the hyperacute phase of infarction. Therefore, their absence does not rule out the diagnosis of an RV infarction in the subacute phase. According to our experience,... 

Figure 13.1 ECGs of two patients, one with non-ischaemic (NIC) and the other with ischaemic cardiomyopathy (IC). Both ECGs have a similar QRS width, LVEF and LVEDD. Note the pronounced voltages of right precordial leads,...

Lopez-Sendon J, Coma-Canella L, Alcasena S, Seoane J, Gamayo C. Electrocardiographic findings in acute right ventricular infarction sensitivity and specificity of electrocardiographic alterations in right precordial leads V4R, V3R, VI, V2, and V3. J Am Coll Cardiol 1985 6 1273. 

Right precordial leads can provide specific information about the function of the right ventricle. Place the six leads on the right side of the chest in a mirror image of the standard precordial lead placement, as shown here. 

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