Correspondence Letter by Kordalis et al Regarding Article, “ECG Response: May 20, 2014” To the Editor: We read with interest the ECG Challenge Response by Philip J. Podrid in the May 20, 2014 issue1 and enjoyed the thorough analysis of the case. We wish to emphasize that, apart from the ECG findings already described, in cases of right ventricular myocardial infarction arising from right coronary artery occlusion, another useful sign is the distribution of ST-segment elevation, which is highest in leads V1 or V2 and decreases toward lead V5. In equivocal tracings, as in the current one, the latter finding could contribute to the final diagnosis. This sign was first described by Geft et al2 in 1984 and can be used for the discrimination between right ventricular myocardial infarction and anterior myocardial infarction in the presence of ST-segment elevation in the precordial leads. We hope that our comment will add to the value of the ECG Challenge.

Disclosures None Athanasios Kordalis, MD George Lazaros, MD, PhD Christodoulos Stefanadis, MD, PhD First Department of Cardiology University of Athens Medical School Hippocration General Hospital Athens, Greece

References 1. ECG response: May 20, 2014. Circulation. 2014;129:2078–2079. 2. Geft IL, Shah PK, Rodriguez L, Hulse S, Maddahi J, Berman DS, Ganz W. ST elevations in leads V1 to V5 may be caused by right coronary artery. Am J Cardiol. 1984;53:991–996.

(Circulation. 2014;130:e127.) © 2014 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org

DOI: 10.1161/CIRCULATIONAHA.114.011532

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Letter by Kordalis et al Regarding Article, ''ECG Response: May 20, 2014'' Athanasios Kordalis, George Lazaros and Christodoulos Stefanadis Circulation. 2014;130:e127 doi: 10.1161/CIRCULATIONAHA.114.011532 Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2014 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539

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