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Circulation, Vol 67, 558-565, Copyright © 1983 by American Heart Association

ARTICLES

The early recognition of right ventricular infarction: diagnostic accuracy of the electrocardiographic V4R lead

HO Klein, T Tordjman, R Ninio, P Sareli, V Oren, R Lang, J Gefen, C Pauzner, E Di Segni, D David and E Kaplinsky

The sensitivity and specificity of ST-segment elevation in the right precordial lead V4R as an early indicator of right ventricular infarction were examined in a consecutive series of 110 patients admitted for acute inferior myocardial infarction. The sensitivity was 82.7%, the specificity 76.9% and the positive predictive value 70% in 58 patients with right ventricular infarction documented by autopsy or a combination of radionuclide ventriculography and one or more of the following tests: echocardiography, technetium-99m pyrophosphate scintigraphy and hemodynamic monitoring. The negative predictive value was 87.7%. Because of its simplicity and its high sensitivity and specificity, recording of V4R should be an intrinsic part of the early evaluation and electrocardiographic examination of acute inferior wall infarction.

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