DSAE STEMI Review, Mod 3: Placement of Special Leads

When do you add additional leads such as V7, V8, V9, V4R?

There are two areas of the heart for which none of the standard 12 leads monitor the electrical activity:

  1.  The Right Ventricle
  2.  The Posterior aspect of the left ventricle

These areas are most accurately monitored by the placement of special leads – V4R, V7, V8, V9.

When do you request these leads?

In the setting of the Acute Inferior STEMI, the patient will frequently have an Acute Posterior and /or RV STEMI. 

Conclusion:  If you make the diagnosis of Inferior STEMI, you should routinely request leads V4R, V7, V8, V9.

For further discussion of the Posterior and RV Infarct, please refer back to Module 1 of this STEMI Review Course.