chapter

10

The 15-Lead ECG

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Chapter 10 Objectives
Describe the benefits of acquiring a 15-lead
ECG Describe the proper lead placement for Leads V4R, V8, and V9 Describe the hemodynamic problems associated with a right ventricular infarction List 3 clinical signs of RVI On a 15-lead ECG, recognize ECG changes for a posterior and right ventricular MI

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Why a 15-Lead ECG?

12-lead alone misses 50% of the AMIs 15-lead ECG increases sensitivity by 23% 23 more out of 100 could be diagnosed

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Acquiring the 15-Lead (V4R)

Run standard 12-lead Lead V4R: 5th IC

space midclavicular on right side Same as left side V4 Attach V4 wire to the V4R position

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Acquiring a 15-Lead (V8, V9)

Posterior leads V8: 5th IC space
midscapular line V9 goes between V8 and the spine Place Lead V5 wire on V8 and V6 wire on V9 Acquire the second 12lead Re-label the new leads

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Right Ventricular Infarction

RV gets blood supply from the RCA Up to 50% of inferior MI will have RVI Preload problems Use nitrates with extreme caution Fluid bolus of perhaps 1 liter or more is indicated

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Clinical Signs of RVI

Jugular vein distention (JVD) Hypotension, either presenting or
following nitro administration Clear lung sounds

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15-Lead ECG

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Practice Cases
Using the 15-Lead

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Page, 12-Lead ECG for Acute and Critical Care Providers 2006 by Pearson Education, Inc. Upper Saddle River, NJ