2

12 Lead ECG Interpretation

PART V
Special Considerations

Dana Yost, Senior Paramedic

Paramedic Training
King County, WA

LISA

Right Ventricular Infarct

Involves Right Coronary
Accompanies up to 40% of inferior MI cases
Poor pump
Hypotension

Right Ventricular Infarct

Right and Left Ventricle affected
Right Ventricle can become a poor pump
Poor cardiac output
Clinical Signs
Distended Neck Veins
Clear Lungs
Hypotention

Right Ventricular Infarct

Treatment

Right sided ECG

Fluid
Cautious with Vasodilators

Right Ventricular Infarct

V6R

V5R

V4R

Proximal RCA Occlusion

V4R

V5R

V6R

So, When you think Inferior Infarct.

Think
Right Sided ECG
&
I.V. Ringers

Posterior Wall MI
(PWMI)

Posterior Wall MI
(PWMI)
Usually an extension of an Inferior or Lateral MI
Common with proximal RCA occlusions
Occurs with LCX occlusions

Indicative Leads
ST

Infarcted Tissue

V7-V9

Posterior Wall

Ischemic Tissue

LV
RV

Reciprocal Leads
R

ST

V1-V4

PWMI
Best to identify with direct leads
Suspect when:
ST depression in V1 V3
R wave progression in V1 V3
Positive T waves in V1 V3

Assoc w/ Inferior or Lateral MI

PWMI
Best to identify with direct leads
ST elevation in V7, V8, V9
ST elevation in posterior leads is evidence of posterior MI

Posterior Leads
V7
Posterior axillary line
Level with V6

V8
Mid-scapular line
Level with V6

V9
Left para-vertebral
Level with V6

Posterior Wall MI
(PWMI)
V7

V8

V9

Summary
A normal 12 Lead ECG does not rule out AMI
Time is Muscle. Pre-Hospital 12 Leads improve Patient outcomes
Doing and interpreting the 12 Lead is fast and easy
Be systematic and use the L - I - S - A method
12 Leads allow you to anticipate complications
Inferior MI = Right sided 12 Lead & I.V. Ringers
Be aware of Imitators