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Right Ventricular Involvement ECG

This is an educational poster aimed at reviewing the involvement of the Right Ventricle in ECG. This poster takes a look at the location of the coronary vessels in the heart and reviews which are the ECG leads that are related to the right ventricle. Lastly, the placement of the 15 lead electrode configuration and the ECG Guidelines for Right Ventricular Infarction (RVI) management are reviewed.

The poster can be downloaded at the end of the page

Location of the Coronary Vessels

Anterior View

Anterior View of the heart

Posterior View

Posterior View of the heart

Related ECG Leads

Anterior View

Anterior View of the heart with related ECG Leads

ACC Guidelines recommend “evidence of RV ischemia/infarction be sought in all patients presenting with inferior ST elevated myocardial infarction” and that it “be assessed with a right precordial V4R lead.

ECG Right Ventricular Involvement

15 Lead Electrode Placement

15 lead electrode placement

ECG Guidelines for RVI Management

ECG Guidelines for RVI Management


(1). Because treatment of infarction may vary with right ventricular involvement, recording of additional right-sided precordial leads during acute inferior wall, left ventricular infarction is recommended. Routine recording of these leads, in the absence of acute inferior infarction, is not recommended. — (Circulation 2007).

(2). Current AHA/ACC Guidelines recommend that “patients with inferior STEMI and hemodynamic compromise should be assessed with a right precordial V4R lead to detect ST Segment elevation and an echocardiogram to screen for RV infarction.” — (Circulation 2004).

(3). RV involvement in acute inferior infarction may be accomponied by significant hemodynamic consequences, including a lowering of cardiac output and systemic blood pressure. — (N Engl J Med 1999).

(4). In addition, the in-hospital mortality of acute inferior infarct is worsened when complicated by RV involvement. — (New Engl J Med 1993).


References: [1] Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation. 2004 Aug 31;110(9):e82-292.

[2] Kligfield P, Gettes LS, Bailey JJ, Childers R, Deal BJ, Hancock EW, et al. Recommendations for the Standardization and Interpretation of the Electrocardiogram. Part I: The Electrocardiogram and Its Technology. A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. Circulation. 2007 Feb 23.

[3] Wellens HJ. The value of the right precordial leads of the electrocardiogram. N Engl J Med. 1999 Feb 4;340(5):381-3.

[4] Zehender M, Kasper W, Kauder E, Schonthaler M, Geibel A, Olschewski M, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med. 1993 Apr 8;328(14):981-8.

  • Circulatory
  • ECG
  • Cardiac care
  • Clinical