Extensive inferior infarction with right ventricular and posterior wall extension

Patient

74-year-old hypertensive man, referred to the emergency department because of four hours existing typical chest pain with cardiogenic shock;

Trace

Bradycardia with narrow QRS; atrial activity difficult to detect; possible regular atrial activity visible in V3 with 2:1 pattern (probable atrioventricular conduction disorder); Q-wave in the inferior territory and from V4 to V6; high amplitude R wave in V1 and V2 compatible with a posterior infarction; tall elevation (Pardee wave) of the ST-segment in the inferior leads with higher ST-segment amplitude in lead III than in lead II; reciprocal depression in lead I and aVL (large amplitude) and in V1-V2; moderate elevation in V4, V5, V6;

Trace

Tracing recorded simultaneously with right-sided and posterior leads; the inferior elevation is associated with a significant elevation in the right leads (V3R, V4R) and in the posterior leads with Q-waves;

Exergue

Risk of sudden death and conduction disorders is particularly elevated in patients with an inferior infarction with right ventricular extension even in the absence of severe left ventricular dysfunction. This risk is temporary, regresses after the acute phase but involves close initial monitoring.