Friday, March 11, 2011

Paucis Verbis: Right and posterior EKG leads


A standard 12-lead EKG can be very telling for patients with chest pain or shortness of breath. A right ventricular (RV) and posterior wall infarct, however, can present very subtly. You can obtain special right-sided (V1R-V6R) and posterior leads (V7-V9), if you are concerned.

What are the indications for obtaining right-sided and posterior EKG leads?


Addendum 3/11/11:
Right sided EKG leads (V1R-V6R) are positioned in a mirror image fashion from the standard 12-lead precordial leads.


Posterior EKG leads (V7-V9) are applied by moving V4-V6 in the posterior positions.

Feel free to download this card and print on a 4'' x 6'' index card.
Thanks to Caitlin for suggesting this topic!
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4 comments:

  1. Once, I would like someone who will show me a picture with the position of the leads!

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  2. Great idea, Gemma. Revised the posting above to include 2 images showing lead placement.

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  3. I want to know what the normal QRS looks like on all 6 of the right precordial leads but cannot find this ANYWHERE on the internet? I have an EKG I did where all 6 right precordial leads showed a QS format for the QRS....is this normal and, if not, what is the significance?

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  4. Good questions, Suzie: Here's a relatively normal right-sided EKG from Dr. Smith's EKG blog:
    http://hqmeded-ecg.blogspot.com/2011/02/inferior-hyperacute-t-waves-clue-is-t.html

    A QS morphology isn't normal. For me, the differential includes an old/subacute infarct. Also is the QS wide or narrow?

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