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15 LEAD ECG FOR ALL PATIENTS

Many authors have described the utility of additional lead placements "15 lead ECG" for better identifying ischemic changes in Right Ventricular and Posterior Myocardial Infarctions.  This usually involves on selected patients doing a second ECG incorporating leads V3R---V4R for Right Ventricular Leads and V8 or V9 for Posterior leads.

Am J Cardiol 1997 Jun 15;79(12):1579-85
Value of posterior and right ventricular leads in comparison to the standard 12-lead
electrocardiogram in evaluation of ST-segment elevation in suspected acute myocardial
infarction.
Zalenski RJ, Rydman RJ, Sloan EP, Hahn KH, Cooke D, Fagan J, Fligner DJ, Hessions W, Justis D, Kampe LM, Shah S, Tucker J, Zwicke D

We have taken advantage of additional lead capabilities in the Hewlett Packard PageWriter Series to routinely add V3R--V4R and V8 on all ECG's done in the Emergency Department without the need to do an additional ECG for alternate lead placement.

 

Note on the lead panel there are normally capped plugs for leads V3R--V4R and V7

• Buy 3 additional leads from HP
• Program using the HP manual for report in Manual Standard + Pediatric Leads .  Auto 3x4 with 3 Rhythm strips.
• Resulting report is standard 12 lead format with 3 Rhythm strips.
• Program Rhythm strips to be V3R,  V4R  and V7
• Actual lead placement is V8 or V9  rather than V7 to better see posterior wall
• Advantage is all patients get 15 leads  so you don't have to figure out ahead of time which patients need it (you might be wrong !)

Posterior MI with Inferior MI

 
 

Alan C. Beamsley, D.O.  6/21/99