ECG in Right Ventricular Myocardial Infarction (Vectorial x Wilson’s Cavity Potential Theory)

 Quintiliano H. de Mesquita, M.D.

The right ventricular infarction has been identified by us since 1958 in the following electrocardiographical features: myocardial infarction of inferior wall patterns in the limb leads; 'QS" wave or abnormal 'Q' wave in the right precordial leads, epicardial leads of the right ventricle and unipolar aVR lead with a high and relatively broad 'R' wave simulating an incomplete left bundle branch block without 'Q' waves in leads 1, aVL and left precordial leads - reciprocal and antagonistic aspects.

In 2 cases submitted by us to anatomopathological study it was proved that there is a correlation between the 'QS' wave and right ventricular infarction showing these electrocardiographical patterns are common in right ventricular infarction, either alone or associated with the inferior myocardial infarction of the left ventricle.

The cavity potential theory of Frank Norman Wilson obviously does not conform with these legitimate electrocardiographical findings, primarily in the right precordial leads (V4R, V5R and V6R), and does not give either a convincing explanation for the secondary, antagonistic and reciprocal left precordial patterns in V4, V5, V6 and V7 leads.

On the other side the Vectorial Theory gives the true explanation regards the genesis of the 'QS' wave or abnormal 'Q' wave due to right ventricular infarction, with the right precordial leads indicating the primary loss of myocardial forces - electronegative area - and the left precordial leads indicating the secondary gain of myocardial forces - electropositive area - with a tall and relatively broad 'R' wave. The left ventricular infarctions localized in the inferoposterior wall (pure posterior or dorsal wall) as well as in the inferolateral, anterolateral and high anterolateral walls show secondary features simulating an incomplete right bundle branch block.

These aspects can be only explained through the Vectorial Theory besides they do not seem to represent conduction defects, merely a gain of electropositive forces. The last three types of myocardial infarction represent the precordial replica of the right ventricular infarction.

In our point of view the acceptance of the Vectorial Theory could reestablish the necessary primacy of the electrocardiography to attend all types of myocardial infarction since the Wilson's cavity potential theory does not conform with the 'QS' deflection which is a clinical and experimental fact in the right ventricular infarction.

Related articles and electrocardiographic images are at:

ECG Vectorial Theory of the Myocardial Infarction

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