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!
Posted by
Labels: ,

10 comments:

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

    ReplyDelete

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

    ReplyDelete
    Replies

    1. Hi Michelle, The first image showing the right lead placement has gone missing...

      Dave

      Delete

    2. Oh my! Fixed. Thanks for finding that and letting me know.

      Delete

  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?

    ReplyDelete

  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?

    ReplyDelete

  5. On the anterior chest wall, v1 v2 are to remain in normal position move v3 to v6 position and follow around the posterior section placing leads as illustrated for v7 v8 v9 by using leads v4 v5 v6 in those slots respectably. IF ALL YOU HAVE IS A 12 LEAD ECG MACHINE and you need a Posterior EKG.
    Please correct me if I am wrong, its the front of the chest for a posteior EKG that is in question?

    ReplyDelete
    Replies

    1. That is correct that we are talking about the precordial (chest) leads. The limb leads stay the same.

      Delete

  6. Be sure to lable EKG Posterior and place v6 v7 v8 v9 correction next to the leads on the ekg tracing to identify to everyone.

    ReplyDelete
    Replies

    1. Excellent point. Clear labeling is key.

      Delete

Subscribe to: Post Comments (Atom)