The Early Recognition of Right Ventricular Infarction

Diagnostic Accuracy of the Electrocardiographic V 4R Lead

  • KLEIN, HERMAN O. M.D.
  • TORDJMAN, THERESE M.D.
  • NINIO, REUVEN M.SC.
  • SARELI, PINCHAS M.D.
  • OREN, VICTOR M.D.
  • LANG, ROBERTO M.D.
  • GEFEN, JACOB M.D.
  • PAUZNER, CHANA M.D.
  • SEGNI, ELLO DI M.D.
  • DAVID, DANIEL M.D.
  • KAPLINSKY, ELIESER M.D.

  • From the Departments of Cardiology and Nuclear Medicine, Meir General Hospital, Sapir Medical Center, Kfar-Saba, and Sackler School of Medicine, Tel-Aviv, Israel.

Address for correspondence: Hermnan 0. Klein, M.D., Meir General Hospital, Kfar-Saba, Israel.

Presented in part at the 54th Scientific Sessions of the American Heart Association, Dallas, Texas, November 1981.

Received December 9, 1981; revision accepted October 4, 1982.

Circulation 67(3):p 558-565, March 1983.

SUMMARY

The sensitivity and specificity of ST-segment elevation in the right precordial lead V4R as an early indicator of right ventricular infarction were examined in a consecutive series of 110 patients admitted for acute inferior myocardial infarction. The sensitivity was 82.7%, the specificity 76.9% and the positive predictive value 70% in 58 patients with right ventricular infarction documented by autopsy or a combination of radionuclide ventriculography and one or more of the following tests: echocardiography, technetium- 99m pyrophosphate scintigraphy and hemodynamic monitoring. The negative predictive value was 87.7%. Because of its simplicity and its high sensitivity and specificity, recording of V4R should be an intrinsic part of the early evaluation and electrocardiographic examination of acute inferior wall infarction.

Copyright © 1983 American Heart Association, Inc.