Value of posterior and right precordial leads in acute myocardial infarction

ABSTRACT

Evaluation of the diagnostic and prognostic value of posterior chest leads [PCL] [V7, V8 and V9] and right chest lead [RCL] [V3R, V4R and V5R] in acute myocardial infarction [AMI]. 44 consecutive patients with AMI were included in this work; serial PCL [V7, V8 and V9] and RCL [V3R, V4R and V5R [and standard 12 leads ECGs were recorded. Accordingly patients were grouped into two groups; Group I with inferior AMI and. Group II with anterior AMI. Each group was subgrouped into A and B according to the presence or absence of changes in PCL and RCL. In-hospital course was assessed and echocardiographic wall motion score index [WMSI] was estimated for every patients. In group I; there were 13 out of 18 patients had changes in RCL and PCL [5 and 8 respectively] and 4 out of 24 patients in group II had changes in RCL and PCL [2 in each]. True isolated posterior AMI was recorded in 2 patients. Patients having changes in RCL and PCL had more frequent in-hospital complications; post MI angina [P<0.05], heart failure [P<0.01], serious dysrrhythmias [P<0.01], mortality [P<0.05]. Also, they had a significant reduction in E.F. [P<0.05] and F.S [P<0.01] and higher WMSI [P<0.01] as compared to those patients without right and posterior precordial leads changes. There were a significant prevalence of right ventricular [RV] and/or posterior myocardial infarction in association with anterior and inferior AMI. The presence of RV and posterior infarction, in addition, had a more adverse outcome. We recommend the routine recording of RV and posterior precordial leads in every patients presented with chest pain. It may improve the identification of the high risk subset of patients and may have an important therapeutic and prognostic implications