[Right ventricular involvement in infero-posterior myocardial infarct: clinical significance of ECG diagnosis].
Right ventricular infarction accompanies acute inferoposterior myocardial infarction in 25 to 53% of cases, the frequency depending on the diagnostic method used. Involvement of the right ventricle can be reliably diagnosed in the right precordial leads of the ECG. Sensitivity and specificity are above 90% and the positive predictive value is over 80%. To assess the clinical value of this extended ECG diagnosis, we retrospectively studied 144 patients with acute inferoposterior myocardial infarction. Right precordial ECG leads V2R to V6R were registered routinely in all of these patients immediately after their admission to the hospital. We found characteristic ECG changes of right ventricular infarction in 31 (22%) of these 144 patients: ST elevation of > or = 0.5 mm in the right precordial leads, especially in lead V4R. In this group of patients the following hemodynamic parameters were registered in a significantly higher percentage: biventricular heart failure (29% vs 4%, p < 0.001), isolated right ventricular failure (23% vs 0%, p < 0.002), arterial blood pressure < 90 mm Hg (48% vs 23%, p < 0.001), cardiogenic shock (13% vs 4%, p < 0.05). Furthermore, the following arrhythmias were found significantly more frequently: sinus bradycardia (42% vs 24%, p < 0.05), AV block II type Mobitz 2 and AV block III (22% vs 5%, p < 0.005). Because of hemodynamic disturbances we had to substitute volume more often (39% vs 1%) or employ catecholamines more frequently (39% vs 6%, p < 0.01). Following high degree AV block we inserted a temporary pacemaker in a higher percentage (13% vs 5%) without reaching statistical significance.(ABSTRACT TRUNCATED AT 250 WORDS)
Kardiologische Abteilung, Medizinische Klinik B, Kantonsspital St. Gallen.
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016278:Ventricular Function, Right