A right-sided 12-lead electrocardiogram (ECG) is performed in specific clinical scenarios, particularly when there is a suspicion of right ventricular (RV) involvement in myocardial infarction or other cardiac conditions. The standard 12-lead ECG primarily focuses on the left side of the heart, which can lead to underdiagnosis of right-sided issues. Therefore, additional right-sided leads can enhance diagnostic accuracy in certain situations.
One of the primary indications for performing a right-sided ECG is in cases of suspected acute RV infarction. The presence of ST elevation in lead V4R, which is part of the right-sided leads, has been shown to have high sensitivity and specificity for diagnosing RV infarction (Sukmawati et al., 2023). This is particularly relevant in patients presenting with inferior wall ST elevation myocardial infarction (STEMI), where RV involvement can significantly affect management and prognosis. In such cases, the right-sided leads can reveal ST segment changes that are not apparent in the standard leads, thus guiding appropriate therapeutic interventions (Iannetta et al., 2013).
Additionally, right-sided ECGs are beneficial in diagnosing conditions such as pulmonary hypertension and arrhythmogenic right ventricular cardiomyopathy. Studies have indicated that the synthesized right-sided chest ECG can improve the detection of pulmonary hypertension, which is often missed with standard leads due to low sensitivity (Nakatsuji et al., 2015). Furthermore, specific QRS morphology patterns in right-sided leads can aid in differentiating arrhythmogenic right ventricular cardiomyopathy from other cardiac conditions (Cortez et al., 2017).
Moreover, right-sided ECGs can be useful in evaluating patients with suspected pulmonary embolism. The right-sided leads can help identify right ventricular strain patterns that are indicative of acute pulmonary embolism, thereby assisting in risk stratification and management decisions (Shopp et al., 2015).
In summary, a right-sided 12-lead ECG should be performed in the following scenarios:
- Suspected Right Ventricular Infarction
When there are signs of inferior wall STEMI, particularly with ST elevation in V4R (Sukmawati et al., 2023).
- Pulmonary Hypertension
To enhance diagnostic accuracy when standard leads show limitations (Nakatsuji et al., 2015).
- Arrhythmogenic Right Ventricular Cardiomyopathy
For better differentiation of this condition from other cardiac diseases (Cortez et al., 2017).
- Pulmonary Embolism
To assess right ventricular strain and guide management (Shopp et al., 2015).
These applications underscore the importance of incorporating right-sided leads in the ECG assessment of patients with specific cardiac concerns, thereby improving diagnostic accuracy and patient outcomes.
References:
- Cortez, D., Svensson, A., Carlson, J., Graw, S., Sharma, N., Brun, F., … & Platonov, P. (2017). Right precordial-directed electrocardiographical markers identify arrhythmogenic right ventricular cardiomyopathy in the absence of conventional depolarization or repolarization abnormalities. BMC Cardiovascular Disorders, 17(1).
https://doi.org/10.1186/s12872-017-0696-x
- Iannetta, L., Puddu, P., Bindo, M., Morabito, G., Grillo, P., Gregorio, C., … & Schiariti, M. (2013). Pathophysiology and ecg patterns of isolated right ventricular infarction with nondominant right coronary artery. Journal of Cardiovascular Medicine, 14(10), 740-744.
https://doi.org/10.2459/jcm.0b013e32835853a3
- Nakatsuji, A., Miyauchi, Y., Iwasaki, Y., Tsuboi, I., Hayashi, H., Uetake, S., … & Shimizu, W. (2015). Detection and evaluation of pulmonary hypertension by a synthesized right-sided chest electrocardiogram. Journal of Nippon Medical School, 82(3), 136-145.
https://doi.org/10.1272/jnms.82.136
- Shopp, J., Stewart, L., Emmett, T., & Kline, J. (2015). Findings from 12‐lead electrocardiography that predict circulatory shock from pulmonary embolism: systematic review and meta‐analysis. Academic Emergency Medicine, 22(10), 1127-1137.
https://doi.org/10.1111/acem.12769
- Sukmawati, I., Goh, F., Yip, A., Loh, P., & Chan, K. (2023). A case report: anteroseptal st elevation due to acute isolated right ventricular infarction. International Journal of Emergency Medicine, 16(1).
https://doi.org/10.1186/s12245-023-00522-z