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Case 39: A 70 year old man with chest pain

on May 07, 2020

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ECG of IWMI

Case 39: A 70 year old man with chest pain, what is the major finding in this ECG?
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ECG

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If you are just starting to learn echocardiography, you will find that learning the full echo examination protocol will be immensely useful. The full protocol will provide a solid foundation for your career in echo. I personally found that once I could execute the standard protocol flawlessly, I was able to add and refine additional echo scanning skills while deepening my understanding of the purpose of each echo image. The echo protocol illustrated in this article is the same one we currently use for all our patients in the hospital and meets or exceeds the standards of American Society of Echocardiography (ASE) for an adult echocardiography examination. The protocol presented here is meant as a guideline and does not cover every aspect (such as off axis views) of an echo examination. Also other hospitals will probably have slight variations of this protocol depending on the lab's needs, which is normal. This article's main purpose is to provide a solid foundation for the be…

How To Spot Right Ventricular (RV) Infarction on ECG

Look at these two ECGs:

Second ECG with "Right sided" Chest leads:

What is your diagnosis?
Can you spot Right ventricular infarction?
Explanation:
Its Inferior Wall Myocardial Infarction with Right Ventricular Infarction as seen on ECG with right sided chest leads.

How To Spot Right Ventricular Infarction?
Spotting Right ventricular infarction is important for management as you have to give lot of fluids and to avoid blood pressure lowering medications such as nitrates in these patients. There are three methods to spot RV Infarction, first is clinical, second method is indirect method on standard 12 lead ECG and at the last Direct (Confirmatory method) on ECG with "Right sided" chest leads.
1. Clinical:
2. Indirect Method:
3. Direct Method:

1. Clinical:

Classic clinical Triad of Right Ventricular Infarction includes Distended Neck Veins with Clear lung Fields & hypotension Other features include Kussmaul sign and Pulsusparadoxus.

2. Indirect Method:
ST segment elevat…

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