Myocardial Infarction: ECG Diagnosis of Right Ventricular Infarction

 Quintiliano H. de Mesquita, M.D.

Some highlights about our past article "ECG in Right Ventricular Myocardial Infarction (Vectorial x Wilson's Cavity Potential Theory) published at this section:

In 1947, our electrocardiographical precordial routine included V3R and V4R leads. In 1958 we identified the isolated infarction at the right ventricle in a patient with infarction of inferior wall through the primary patterns of infarction (QS, RS-T (+) and T (+-)) in the right ventricular area registering with V3R – V6R leads the ECG mapping from the second, third, fourth and sixth right intercostal spaces plus secondary patterns of infarction: R, RS-T (-) and T (-+) in the left ventricular area (V4-V6) plus V7R and all the leads of thorax posterior wall (Mesquita, Q.H., Arq. Bras. Cardiol. 1960; 13:162).

These electrocardiographical abnormalities remained in this patient during 9 months when we have had the opportunity to record in the course of a thoracotomy the epicardial leads of right ventricle presenting deflections of QS, QR, RS-T (+) segments and T (+-) waves and presenting in the left ventricle deflections of RS and isoeletric RS-T segments and T (+-) waves. Thereafter such ECG patterns became a standard for our diagnosis in pure infarction of right ventricle.

Following with our studies we started to record cases of associated infarction from right and left ventricles through the primary patterns of infarction, simultaneously, in right ventricular area (V1-V3R-V6R) and left ventricular area (V1-V6), either in patients with infarction of inferior wall as in patients with infarction of anterior wall.

I must accentuate that in experimental studies from Wilson et al realized in 1932 (Johnston & Lepeschkin: Selected papers of Doctor Frank N. Wilson, Edwards Brothers, Ann Arbor; 1954 p. 635) and by Bakos A.C.P. (Circulation, 1950; 1:724) about the infarction of free wall from the right ventricle, were recorded by these authors the epicardial leads with QS deflection, finding which contradicted the cavity potential theory. The QS pattern is, in our point of view, perfectly compatible with the Vectorial Theory defended by us.

 Related articles and electrocardiographic images are at:

ECG Vectorial Theory of the Myocardial Infarction

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