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European Heart Journal 1988 9(9):955-961;
Copyright © 1988 by the European Society of Cardiology.
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© 1988 The European Society of Cardiology

Vectorcardiographic criteria for acute right ventricular infarction

W. CARSON, Y.-Z. TSENG, C.-D. TSENG, P.-J. HUANG and T.-L. WU

Cardiovascular Division of the Department of Medicine, National Taiwan University Hospital Taipei, Taiwan, Republic of China

Received 17 August 1987; revised 17 February 1988; .

Address for correspondence and reprints Dr Wangden Carson, M.D., D.PH, the Cardiac Department, John Radcliffe Hospital, University of Oxford, Headington, Oxford OX3 9DU. U.K.

Abstract

Based on serial vectorcardiographic and cardiac scintigraphic studies of 62 patients with acute myocardial infarction, we propose vectorcardiographic criteria for the diagnosis of acute right ventricular infarction. These criteria are: (1) the direction of the maximal spatial ST vector points either to the right-anterior-inferior or to the right-posterior–inferior octant, and (2) the magnitude of the projection of the maximal spatial ST vector is ≥0.15 mV in the horizontal plane. By using these criteria correlated with scintigraphic results, 92% sensitivity was achieved together with 98% specificity; the Kappa statistic was 0.90. In patients with acute inferior and right ventricular infarction, the serial maximal spatial ST vector swung to-and-fro like a ‘tug of war’ between right-anterior-inferior and right-posterior-inferior octants during the acute stage. In patients with acute inferior-posterior and right ventricular infarction, the serial maximal spatial ST vector pointed to the right-posterior-inferior octant during the whole course of the acute stage. Failure to recognize this electrical phenomenon may make the clinician inaccurate when judging the clinical course of acute right ventricular infarction or over-estimate the result of therapeutic intervention.

Key Words: vectorcardiographic criteria • acute right ventricular infarction


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