Electrical reciprocity on the ECG and Right Ventricular MI
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| Waht is electical reciprocity? | ST elevations in one group on the ECG will show up as ST depressions in the other. Not ischemia – “mirroring”.
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| Which areas of the heart show reciprocal changes to one another? (2) | 1. Inferior and Lateral
2. Septal and Posterior
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| 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)
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| 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.)
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| True or false? The septal leads can mirror the activity in the posterior portion of the heart. | True
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| 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.
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| 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.
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| 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.
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| 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.)
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| 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.)
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| Where is the Vl wire attached? | To the 4th electrode.
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| 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.
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| What is it called when both the inferior and posterior portions of the heart are being infarcted? | A right ventricular MI (RVMI)
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| What happens to the right ventricle during a RVMI? | It becomes hypokinetic (it doesn't move much.)
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| 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)
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heart2heart
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