12 Leads

EMT11KDL

EMT11KDL

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So I was just looking in the Case Study, and someone posted a case review of a possible cardiac with a 12 lead. The 12 lead showed about 1mm ST elevation in the Inferior leads, and personally I would be doing Right Side Leads on the patient to confirm it is just inferior and not Right Side involvement. How many of you guys do Right Side Leads, and posterior leads on patients in the field?
 
I do both right sided and posterior leads.
 
I have not done a right sided or posterior 12-lead yet. When I interpret 12-leads online, I kinda consider posterior and right sided 12-leads not necessary.

A posterior MI, you will see reciprocal changes in the anterior leads. In one case from ems12lead I believe, there was slight ST elevation in V6 because it is closer to the posterior wall. Often, I see early R-wave progression too (opposite of anterior wall MI, where the R-wave progress a little bit later).

For right ventricular involvement, you'll see greater ST elevation in lead III than in lead II. Another thing that might look weird is ST elevation in lead V1, but ST depression in lead V2. Even without doing right sided leads, y'know there is gonna be some right sided involvement in inferior wall MI due to the right coronary artery (RCA) usually being the culprit. Less commonly the left circumflex or very rarely the left anterior descending (LAD) are the culprit, and they will appear differently. When the culprit is the LAD (for inferior wall MI), it presents so weirdly with such wide spread ST elevation that I see people usually screaming "pericarditis". :[

Not sure if this is a bad habit, but that may be why I haven't done right sided or posterior 12-leads in the field yet. Online, I don't feel like either of those have revealed shocking information I didn't get from a regular 12-lead.
 
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I make my decision on a case by case basis, but with that being said I do right sided ecg's a lot. I do do posterior leads, but less often.
 
Depending on circumstances, a case by case basis, I will do right sided 12Leads.
 
Aprz said:
I have not done a right sided or posterior 12-lead yet. When I interpret 12-leads online, I kinda consider posterior and right sided 12-leads not necessary.

A posterior MI, you will see reciprocal changes in the anterior leads. In one case from ems12lead I believe, there was slight ST elevation in V6 because it is closer to the posterior wall. Often, I see early R-wave progression too (opposite of anterior wall MI, where the R-wave progress a little bit later).

For right ventricular involvement, you'll see greater ST elevation in lead III than in lead II. Another thing that might look weird is ST elevation in lead V1, but ST depression in lead V2. Even without doing right sided leads, y'know there is gonna be some right sided involvement in inferior wall MI due to the right coronary artery (RCA) usually being the culprit. Less commonly the left circumflex or very rarely the left anterior descending (LAD) are the culprit, and they will appear differently. When the culprit is the LAD (for inferior wall MI), it presents so weirdly with such wide spread ST elevation that I see people usually screaming "pericarditis". :[

Not sure if this is a bad habit, but that may be why I haven't done right sided or posterior 12-leads in the field yet. Online, I don't feel like either of those have revealed shocking information I didn't get from a regular 12-lead.
Click to expand...

You don't need V4R to tell you that your hypotensive patient with inferior elevation is most probably having a right sided MI, but it's in everyone's best interest to get these recordings if it doesn't interfere with pt care. Just my opinion.
 
I get them, but it's usually to confirm what I already expect. That, and to officially meet heart alert criteria of needing two contiguous leads with elevation. I've yet to run one and see something I didn't already think was going to be there.
 
To echo what's been said, I'll get a Right sided 12 to confirm right wall involvement along with the brady and hypotensive patient. If any depressions in the anterior leads I'll obtain a posterior 12 lead
 
R side frequently, never felt need to get posterior view. All potential posterior wall infarction we're assoc'd w/ inferior and lateral wall STE. Getting posterior leads would be purely academic and a waste if time otherwise in those situations. I'd consider posterior views if isolated ST depression in V1 and V2.
 
I used to obtain them in all inferior/posterior MI patients...now I follow the evidence and record them only if I have time or am teaching. The addition of V4R or V7-9 does not improve my accuracy, sensitivity, or specificity. (I'm also comfortable calling a "STEMI" without using the established "criteria", so take that with a grain of salt.)
 
I rarely, if ever, do anything more than a standard 12 lead. Here, if we call a STEMI in, the hospital is going to do their own ECG and make their own, independent determination as to whether the patient needs to go to a cath lab so... this is not a diagnostic procedure in the field.
 
I typically do them when I see changes indicative of a posterior wall MI and/or with an inferior wall MI. I typically do V4R and V8 and V9 when I do them.
 
I gather both right-sided and posterior leads when needed or when the EKG is suspicious of such.
 
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