Document Detail

Electrocardiographic tall R waves in the right precordial leads. Comparison of recently proposed ECG and VCG criteria for distinguishing posterolateral myocardial infarction from prominent anterior forces in normal subjects.
MedLine Citation:
PMID:  2341816     Owner:  NLM     Status:  MEDLINE    
Electrocardiographic tall R waves in the right precordial leads may be present in patients with posterior myocardial infarction, right ventricular hypertrophy, various conduction disturbances, and some forms of cardiomyopathy and in clinically otherwise normal subjects with prominent anterior electromotive forces. Clinical uncertainty most often arises in distinguishing possible prior posterolateral myocardial infarction (PMI) from the unusual normal variant (PAF). The ECGs and VCGs of 15 subjects with posterolateral infarction were compared with tracings from 12 subjects with no evidence of cardiac disease, all individuals demonstrating tall R waves (R/S greater than 1.0 in V1 and/or V2) in the right precordial leads on surface ECG. By standard ECG, the infarction group was characterized by taller T waves in leads V1 and V2, shorter T waves in V6, greater T2-T6 index, and a more negative two variable function as described by Nestico. By VCG, the infarction group was characterized by a more anteriorly oriented T loop, more leftward maximal frontal plane QRS vector and a lower calculated -45 degrees/ab, as described by Suzuki. An algorithm was proposed that permitted proper classification (PAF vs. PMI) based on ECG criteria in 75% of subjects with 90% accuracy. This compared favorably with performance of the Frank vectorcardiogram, including using more recently proposed criteria. Routine use of the VCG, therefore, in this clinical setting may no longer be justified.
M J Zema
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of electrocardiology     Volume:  23     ISSN:  0022-0736     ISO Abbreviation:  J Electrocardiol     Publication Date:  1990 Apr 
Date Detail:
Created Date:  1990-06-25     Completed Date:  1990-06-25     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0153605     Medline TA:  J Electrocardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  147-56     Citation Subset:  IM    
Department of Medicine, Brookhaven Memorial Hospital Medical Center, Patchogue, New York.
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MeSH Terms
Diagnosis, Differential
Heart Conduction System / physiopathology
Middle Aged
Myocardial Contraction / physiology
Myocardial Infarction / diagnosis*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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