Simultaneous ST-segment elevation in lead V1 and depression in lead V2: a discordant ECG pattern indicating right ventricular infarction

The major electrocardiographic change in right ventricular infarction (RVI) is ST-segment elevation in leads V4R-V6R. The authors describe a discordant electrocardiographic pattern of ST-segment elevation in lead V1 and ST-segment depression in lead V2 in five patients presenting with acute transmural (Q wave) inferior infarction and RVI. There were 51 patients with transmural inferior infarction from a thrombolytic trial. In 25 patients, the ST-segment in the right-sided precordial leads was elevated by > or = 1 mm indicating the presence of RVI. In 5 of these 25 patients, simultaneous ST-segment elevation of 1.0-8.0 mm (mean, 2.8 +/- 2.9 mm) in lead V1 and ST-segment depression of 2.5 to 4.0 mm (mean, 3.3 +/- 0.6 mm) in lead V2 were also present. The discordant pattern of the ST-segments in leads V1 and V2 is an important and specific sign for RVI.