Right ventricular infarction mimicking anterior infarction

Abstract

It is rare to observe ST elevation in anterior derivations caused by right ventricular branch occlusion. We described the case of a patient with unstable angina who developed acute right ventricular myocardial infarction with ST-segment elevation in anterior precordial leads (V(1)-V(4)) shortly after coronary angiography. Coronary angiogram revealed total occlusion of the right coronary artery (RCA) proximally to the right ventricular branch. This reminds us that the presence of diffuse ST-segment elevation in the precordial leads could be due to acute RCA occlusion. The differentiation of these two entities is important, as their therapies are quite different.

Figure 1

(A) ECG on admission showing normal sinus rhythm without ECG abnormalities. (B) Sinus bradycardia, 1.5 mm ST elevation in the inferior leads, 2–3 mm of ST‐segment elevation in precordial leads V₁–V₄ and a ST depression in lateral leads. (C) Resolution of ST elevation in leads V₁–V₄.

Figure 2

(A) A 40–50% stenosis at the middle part of the left anterior descending artery, 40–50% stenosis at the proximal part of the first diagonal branch, subtotal occlusion at the proximal part of the left circumflex artery. (B) A 90% stenosis at the proximal part, 95% eccentric stenosis at the level of right ventricular branch, and 95% stenosis at the distal part. (C) Complete occlusion at the proximal part. (D) Restoration of flow.