Right-sided lead V4R
ECG leads / veins · V4R
V4 mirrored onto the right chest in the fifth intercostal space at the right midclavicular line; ST elevation of 1 mm here is the most sensitive ECG sign of right ventricular infarction and is transient, so record it early in every inferior STEMI.
Traced from the start
Detail
- Territory
- Right ventricular free wall (RCA)
- Threshold
- ST elevation of 1 mm in V4R; disappears within hours of onset
When it goes wrong
ST elevation in V4R in an inferior STEMI
RV infarction: fluid-load for hypotension, withhold nitrates, expect bradyarrhythmia and AV block
Practise this structure
1 question in the bank tagged Coronary Circulation.