Inferior infarction with right ventricular extension

Patient

67-year-old man, hypertensive, active smoker, hospitalized 6 hours after the onset of an oppressive retrosternal chest pain, irradiating in the jaws; arterial hypotension (90/60 mm Hg); ,

Trace

Sinus node dysfunction with moderately increased QRS (115 ms) during escape rhythm; probable retrograde atrial conduction (atrial activity in the initial portion of the T-wave, negative in the inferior leads); Q-wave in the inferior leads; poor R wave progression from V1 to V3; ST-segment elevation (Pardee wave) in the inferior leads with ST-segment amplitude > in lead III than in lead II; reciprocal depression in leads I and aVL; moderate elevation in V3, V4, V5; the moderate elevation in V1 is evocative of a possible right ventricular extension;

Trace

Tracing recorded simultaneously with the right (V3R, V4R) and posterior leads (V7, V8, V9); the inferior elevation is found associated with a significant elevation in the right leads and the presence of deep Q-waves in the right leads;

Exergue

The diagnosis of right ventricular extension during an inferior infarction requires the early and systematic recording of right precordial leads, the observed elevation most often disappearing within 12 hours after the onset of symptoms.