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Reciprocity and RVMI

Electrical reciprocity on the ECG and Right Ventricular MI

QuestionAnswer
Waht is electical reciprocity? ST elevations in one group on the ECG will show up as ST depressions in the other. Not ischemia – “mirroring”.
Which areas of the heart show reciprocal changes to one another? (2) 1. Inferior and Lateral 2. Septal and Posterior
So which leads are reciprocal to the Inferior and Lateral areas of the heart? ll, lll, and AVF (Inferior) with l, AVL, V5, and V6 (Lateral)
So which leads are reciprocal to the Septal and Posterior areas of the heart on a normal 12 lead ECG? N/A (there are no posterior leads on a normal 12 lead ECG.)
True or false? The septal leads can mirror the activity in the posterior portion of the heart. True
How might you get a rough, preliminary view of the electrical activity in the posterior portion of the heart? Look at the septal leads (Vl and V2)backwards and upside down with good lighting behind the image.
How do you get the best view of the electrical activity in the posterior portion of the heart? Perform a right sided 12 lead ECG.
When would you need to do a right sided ECG in order to view the electrical acivity of the posterior portion of the heart? If there are changes in the septal leads (Vl and V2), especially if there are ST Elevations in the inferior leads (ll,lll,and AVF)and ST Depressions in the septal leads.
Why would you need to do a right sided ECG if there are ST Elevations in the inferior leads (ll,lll,and AVF)and ST Depressions in the septal leads Because if the inferior portion of the heart is infarcted the posterior portion may also be. (Remember that the inferior and posterior heart areas are both fed by the RCA.)
How do you correctly apply the electrodes for a right sided ECG? Apply the electrodes the same as you did on the left, but instead put them on the right. Add 3 more electrodes after V6 (V7,8, and 90 using the same spacing as the other electrodes have and keeping in line with V5 and V6 (along the 5th intercostal space.)
Where is the Vl wire attached? To the 4th electrode.
Where are the rest of the wires attached? The V2 wire goes on the V5 electrode, V3 wire on the V6 electrode and so on.
What is it called when both the inferior and posterior portions of the heart are being infarcted? A right ventricular MI (RVMI)
What happens to the right ventricle during a RVMI? It becomes hypokinetic (it doesn't move much.)
What do you do for a patient with a RVMI? Give a lot of isotonic IV fluids! Liters and liters...maybe 10 or more in a day!! (maintain a blood pressure)
Created by: heart2heart
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