Reversing lead IV

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jeremy83

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Confused with my cardiology - why do we reverse lead IV on a 12-lead? I must have blanked out during lecture because this part completely escaped me and I can't find it anywhere. THanks.
 
truetiger said:
If you're referring to V4 its to screen for RVI.
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V4R. But yeah, if that's not what you mean, I have no idea what you're referencing.
 
Pt's with evidence of Inferior infarction should have V4R performed to confirm right ventricular involvement, which has higher mortality and can influence treatment such as the decision to use nitrates.
 
IIRC, 30% of inferior MI's (II,III, aVf) can have rt ventricular involvement. This is why the V4R is so important to record. If you have a rt ventricular MI, nitrates will reduce pre-load, and quickly drop the pt's BP. You'll want to withhold nitrates until you do a 12 and the V4R. In the event of cardiogenic shock, if you have evidence of a rt sided MI, you can infer that a fluid bolus may work better than a dopamine drip.
 
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