The use of non-standard precordial lead placement during the initial assessment of patients with suspected inferior infarction is vital to the diagnosis of right ventricle myocardial infarction, says Cormac Norton

Effective treatment for acute myocardial infarction (AMI) is dependent on accurate diagnoses of the site of infarction. Left ventricular myocardial infarction (LVMI) is the most common form of infarction, of which inferior is the most common site. Patients who have experienced inferior infarctions have a better survival rate than those who have experienced AMIs at other sites. Around one quarter of AMIs affect the right ventricle, and the risk of morbidity for patients who have experienced right ventricular myocardial infarctions is greater than that for patients who have experienced LVMIs. Some authors suggest this is because right-sided heart dysfunction is rarely assessed in standard electrocardiography (ECG), and so opportunities for accurate diagnoses are missed. This article describes how non-standard precordial ECG lead placement can increase the likelihood of diagnosis and therefore improve patient outcomes.