The hyperacute phase of right ventricular infarction

In summary, the hyperacute phase of RV infarction presents three possible patterns on the surface ECG (Fig. 3): (1) the typical repolarization picture of hyperacute myocardial infarction, with slope elevation of the ST segment and tall T waves; (2) rounded elevation of the ST segment, where the typical changes are 'damped' by negative or posterolaterally directed, LV repolarizing forces; and (3) ST elevation concave upward in the right chest leads, where anteriorly directed, underlying left ventricular ST segment and T wave vectors enhance the hyperacute picture.