ECG Right and Posterior Leads
ECG: Right and Posterior Leads
Right Sided ECG Leads
Right sided ECG leads (V1R-V6R) are positioned in a mirror image fashion to the standard 12-lead precordial leads.
- Purpose: To detect right ventricular (RV) infarcts
- RV infarcts usually associated with inferior wall AMI
- Indications: 2004 ACC/AHA guidelines state to get a right-sided ECG in setting of inferior AMI (ST elevation in II, III, AVF)
Hints of an associated RV infarct:
- Hypotension (RV infarcts are extremely preload dependent)
- STE in III is taller than ST elevation in II
- STE in V1
- ST depression (STD) in V2 or V3 relative to V1
Posterior ECG leads
Posterior ECG leads (V7-V9) are applied by moving V4-V6 to under the left scapula.
Purpose: To detect posterior infarcts, which are often associated with inferior or lateral wall AMI
Indications:
- STD in V1-V3, or
- R/S amplitude ratio in V1 or V2 is >1
Hints of an associated posterior infarct:
- Deep T wave inversion in V1 or V2 (in hyperacute stage)
- Upright T wave waves (in later stage)