Page 331 - ECG dr shamol_Slide

ST-segment depressions represent subendocardial or non-transmural ischemia. However,

in the right precordial leads (V1-V3) your differential for ST-segment depression should

include right ventricular hypertrophy with strain and posterior STEMI in addition to anterior
subendocardial ischemia. Similarly, the differential for tall R-waves in leads V1-V3 should

include the possibility that they represent posterior Q-waves or that upright T-waves may

actually be posterior T-wave inversions. It is important to rethink the approach to the ECG

and to maintain a high index of suspicion for PMI when the following findings are seen on
the standard ECG:

1. ST-segment depression (horizontal >> downsloping or upsloping) in leads V1-V3

2. Prominent upright T-waves in leads V1-V3
3. Combination of horizontal ST-segment depression with

4. Prominent R-waves in leads V1-V3

5. R/S ratio > 1 in lead V2

6. Co-existing acute inferior and/or lateral myocardial infarction