Inferior MI with RV infarct

A 68 yo M with ESRD (on HD) brought in by EMS after a syncopal event at home. He was found to be bradycardic (30s) in junctional rhythm with hypotension and eventually found to have inferior ST elevation with reciprocal changes.  We talked about how to recognize an RV infarct in the setting of inferior STEMI by using; if STE in lead III >> II this can indicate RV involvement with a high sensitivity although low specificity. Donot forget to get the right sided EKG! STE in V4R is more sensitive and specific for RV infarct.

References: Right heart ischemia; Gp IIb-IIIa inhibitor in STEMI;