Title says it all.

We’ve noticed from our audits that there are a lot of non-Inferior STEMI cases have a modified 12-Lead completed.

The modified 12-Lead (V4R) is very important as this lead will pick out the portion of Inferior STEMIs that have Right Ventricular involvement. Right ventricular infarcts can cause the right ventricle to pump ineffectively (as this part of the heart tissue is ischemic and does not work properly). This can make the heart very preload sensitive. If nitroglycerine were administered, this would drop the preload, causing serious hypotension and worsening of the cardiac function may ensue.

However, if there is no Inferior involvement on the 12-Lead, there is no need to a modified as there is no Right Ventricle involvement.

Therefore, if you find yourself with an Inferior STEMI (Leads II, III, AvF): Do a modified 12-Lead to ensure nitroglycerine can be safely administered! If you have a non-Inferior STEMI: No need for the modified.

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