The 12 Leads of Christmas: V4

This article is the eighth in our latest series, The 12 Leads of Christmas, where each day we examine a new finding particular to an individual electrocardiographic lead. Like aVF, V4 is a tough lead to discuss on its own. It’s part of the natural flow of the complexes across the precordium and it is certainly nice to have, but because it’s so closely related to V3 and V5 there isn’t a whole lot that makes it unique. The two topics we’ll discuss today involve, but are not isolated, to V4. First off, I can’t discuss V4 without mentioning the work of our blog’s good friend and mentor, Dr. Stephen Smith, on differentiating early repolarization from subtle anterior STEMI. The formula he and his team derived uses the R-wave amplitude in V4 as one of the three variables in an equation that can be utilized as a decision-aid in the evaluation of these difficult EKG’s. A series of cases displaying how and when to use the formula can be found here on his site. The article describing the derivation of the formula can be found here (free full text!). A simple form for calculating the value is available on the right-hand sidebar of Dr. Smith’s site. Alternatively, a simple calculator is also available on the MDCalc site. Earlier this year he was nice enough to feature a case of mine that really shows off the utility of the formula (among other lessons). Here’s a link to the full case description, while the image below is merely a tease...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: 12-Leads of Christmas Original Articles Vince DiGiulio Source Type: research