Precordial ST-Segment Elevation Caused by Proximal Occlusion of a Non-Dominant Right Coronary Artery

Abstract

For patients with ST-segment elevation myocardial infarction, primary percutaneous coronary intervention to the culprit lesion via electrocardiographic guidance is essential. We herein report the rare case of a 49-year-old man who presented with ST-segment elevation in the precordial leads, while coronary angiography results indicated total occlusion of the proximal non-dominant right coronary artery. We evaluated its possible pathophysiologic mechanisms and thoroughly discussed isolated right ventricular infarction and its electrocardiography findings.

Key words: Coronary angiography; Myocardial infarction; Total occlusions.

Figure 1

(A) Electrocardiography (ECG) performed in another hospital showed hyperacute T wave in leads V1-4. (B) ECG obtained at our emergency department showed convex ST-segment elevation over leads V1-3. (C) Follow-up ECG after primary percutaneous coronary intervention showed complete resolution of ST-segment elevation over leads V1-V3.

Figure 2

(A and B) Coronary angiography showed total occlusion of the proximal right coronary artery (RCA) and mid-50% stenosis of the left anterior descending artery. There was mild atherosclerosis of the left circumflex artery. (C) After percutaneous coronary intervention, coronary angiography showed restoration of the RCA with thrombolysis in myocardial infarction (TIMI)-3 flow and grade 2 myocardial blush. (D) Massive thrombus was obtained by repeated manual thrombus aspiration of the RCA.