Standard 12-lead ECG versus special chest leads in the diagnosis of right ventricular myocardial infarction

The case of a 60-year-old woman with an acute inferior transmural myocardial infarction associated with a right ventricular myocardial infarction provided an opportunity to compare the performance of the 12-lead electrocardiogram (ECG) and the right chest leads in the diagnosis of infarction of the right ventricle. While the right chest leads revealed unequivocal evidence of ischemic injury emanating from the right ventricle, the standard leads II and III showed changes compatible with inferior myocardial infarction; familiarity with vectorial interpretive concepts of ST segment deviations could provide a hint of an associated right ventricular involvement. This report is presented at a time of renewed controversy regarding the necessity of special ECG leads in the diagnosis of acute right ventricular infarction in the routine emergency department environment.