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Adult Nurse Practitioner Exam Prep

Category - AANPCP Adult Nurse Practioner Practice Test

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A 75-year-old female client comes to the office complaining of severe angina unresolved by nitroglycerin, which started 2 hours earlier. Physical examination reveals hypotension, clear lung fields, and elevated jugular pressure. A deep and labored breathing pattern is noted. Infarct in the right ventricle is diagnosed.

Which of the following 12-lead ECG findings is the single most powerful predictor of right ventricular infarction involvement within 10 hours of the onset of symptoms?
  1. ST-segment elevation in lead V4R
  2. ST-segment elevation in lead V1
  3. ST-segment depression in lead V3R
  4. ST-segment elevation in lead V3R
Explanation
Answer - A - The ST-segment elevation in lead V4R is the most predictive indicator of right ventricular involvement. This finding is 93% sensitive and 95% specific to right ventricular infarct. This elevation is transient, disappearing in less than 10 hours after the onset of the symptoms. ST-elevations in leads V1 and V3R are less sensitive and less specific in detecting the involvement of the right ventricle.
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