Right sided and posterior EKGs

 Q: If posterior wall ischemia is suspected on EKG, it may help to obtain another EKG by putting? (select one) 

A) V4, V5, and V6 leads on right side of the lower anterior chest area

B) V7, V8, and V9 leads below the left scapula area

Answer: B

If posterior wall ischemia is suspected due to prominent R waves and ST depressions in leads V1 and V2 on initial EKG, it may help to do another EKG by putting leads V7, V8, and V9 below scapula (posteriorly on the chest). This will demonstrate ST elevation on lead V4, V5 and V6.

 Similarly, if inferior wall ischemia is expected in leads II, III, and aVF, putting leads V4R, V5R, and V6R at right sight of the chest will show significant ST elevations in these Leads. This is popularly known as right-sided EKG.

#cardiology

References:

1. Katoh T, Ueno A, Tanaka K, Suto J, Wei D. Clinical significance of synthesized posterior/right-sided chest lead electrocardiograms in patients with acute chest pain. J Nippon Med Sch. 2011;78(1):22-9. doi: 10.1272/jnms.78.22. PMID: 21389644. 

2. Teigeler TL, Ellenbogen KA, Padala SK. The Right-Sided ECG for the Right Diagnosis. Circulation. 2018 Jul 3;138(1):107-109. doi: 10.1161/CIRCULATIONAHA.118.035254. PMID: 29967235.