Diagnosis of Right Ventricular Infarction

Introduction to Right Ventricular Infarction

The European Society of Cardiology recommends that right ventricular infarction (RVI) should be suspected in patients with inferior myocardial infarction, as RVI occurs frequently as a complication of inferior myocardial infarction involving the right coronary artery 1, 2, 3

The standard 12-lead electrocardiogram (ECG) is not sufficient to diagnose right ventricular infarction, and additional right precordial leads (V3R and V4R) are required for electrocardiographic identification 1, 2, 3
The European Heart Society guidelines state that elevation of the ST segment ≥0.5 mm in leads V3R and V4R is diagnostic of right ventricular infarction 4, 3

The American Heart Association recommends obtaining a standard 12-lead ECG within 10 minutes of first medical contact, followed by immediate registration of right precordial leads V3R-V4R if there is ST elevation in inferior leads (II, III, aVF) 3, 5
The European Society of Cardiology guidelines suggest that if there is ST elevation in inferior leads, right precordial leads V3R-V4R should be registered immediately to identify concomitant right ventricular infarction 1, 2, 3

The European Society of Cardiology recommends that the ECG should be complemented with cardiac biomarkers (troponins) to confirm myocardial necrosis 1, 4
Serial ECGs should be performed every 15-30 minutes if the initial ECG is non-diagnostic but symptoms persist 4, 5
Urgent coronary angiography should be considered when there is high clinical suspicion even without diagnostic ST elevation 3