Korean Circ J.  2010 May;40(5):219-223. 10.4070/kcj.2010.40.5.219.

Normal ST Segment Elevation and Electrocardiographic Patterns in the Right-Sided Precordial Leads (V3R and V4R) in Healthy Young Adult Koreans

• Kim WY
• Park JS
• Kim W

• KMID: 1456365
• DOI: http://doi.org/10.4070/kcj.2010.40.5.219

Abstract

BACKGROUND AND OBJECTIVES
It is important to analyze right-sided chest electrocardiograms (ECGs) to rule out combined right ventricular infarction in patients with inferior wall infarction. However, the patterns of right-sided chest ECGs in healthy adults have not been thoroughly investigated. This study was conducted to analyze the normal patterns of ECGs and the prevalence of ST segment elevation (STE) in the right-sided precordial leads (V3R and V4R) in healthy adult Koreans.
SUBJECTS AND METHODS
One hundred thirty healthy male volunteers who registered at the Armed Forces Daejeon Hospital for military recruitment were enrolled between December 2006 and April 2007. Standard 12-lead ECGs and right-sided precordial ECGs were obtained. The characteristic features of the QRS complex configuration, STE, and T wave morphology from right-sided precordial ECGs were analyzed.
RESULTS
The most common QRS configuration in right-sided precordial leads was the rS pattern. The Q waves were present in lead V4R in 4.6% of the study population. STEs of 0.5-1 mm were present in 25.4% of V3R recordings and 6.2% of V4R recordings. T waves were usually negative in the right-sided precordial leads. However, if there was a STE in V4R, the associated T waves were usually positive. There were statistically significant correlations between STEs in V4R and STEs in II, III, aVF, V1, V3, and V6 (p<0.01).
CONCLUSION
The STEs, Q waves, and T wave inversions in the V3R and V4R leads were relatively common findings in young, healthy, Korean adults. However, there were no cases in which there was a STE > or =1 mm and a STE concurrently with a q wave.

Keyword

Myocardial infarction; Electrocardiogram; Pattern

MeSH Terms

Adult
Arm
Electrocardiography
Humans
Infarction
Male
Military Personnel
Myocardial Infarction
Prevalence
Thorax
Young Adult

Reference

1. Manoharan G, De Bruyne B. Right ventricular myocardial infarction. Heart. 2005. 91:e40.

2. Croft CH, Nicod P, Corbett JR, et al. Detection of acute right ventricular infarction by right precordial electrocardiography. Am J Cardiol. 1982. 50:421–427.

3. Zehender M, Kasper W, Kauder E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med. 1993. 328:981–988.

4. Jacobs AK, Leopold JA, Bates E, et al. Cardiogenic shock caused by right ventricular infarction: a report from the SHOCK registry. J Am Coll Cardiol. 2003. 41:1273–1279.

5. Pfisterer M. Right ventricular involvement in myocardial infarction and cardiogenic shock. Lancet. 2003. 362:392–394.

6. Braat SH, Bruqada P, den Dulk K, van Ommen V, Wellens HJ. Value of lead V4R for recognition of the infarct coronary artery in acute inferior myocardial infarction. Am J Cardiol. 1984. 53:1538–1541.

7. Reddy GV, Schamroth L. The electrocardiology of right ventricular myocardial infarction. Chest. 1986. 90:756–760.

8. Cha KS, Kim YD, Kim MH, Kim HK, Kim JS. Usefulness of the initial electrocardiogram for predicting the infarct-related artery in acute inferior myocardial infarction. Korean Circ J. 1998. 28:1096–1104.

9. Huszar RJ. Basic Dysrhythmias. 2007. Revised Third ed. Elsevier;331.

10. Cohn JN, Guiha NH, Broder MI, Limas CJ. Right ventricular infarction, clinical and hemodynamic features. Am J Cardiol. 1974. 33:209–214.

11. Tan CC, Hiew TM, Chia BL. Right chest electrocardiographic patterns in normal subjects. Chest. 1990. 97:572–575.

12. Saito K, Suga Y, Nakanishi K, Hosoi E, Nomura M, Nakaya Y. The right chest electrocardiogram in normal subjects. Kokyu To Junkan. 1993. 41:565–569.

13. Feola M, Ribichini F, Gallone G, Ganzit G, Gribaudo C. Analysis of right electrocardiographic leads in 195 normal subjects. G Ital Cardiol. 1994. 24:375–379.

14. Gill GC, Cho JG, Kang JC. The normal right chest electrocardiogram in healthy Korean adults. Korean J Intern Med. 1990. 38:673–678.