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Case Reports
. 2021 Mar 16;9(8):1877-1884.
doi: 10.12998/wjcc.v9.i8.1877.

Chest pain showing precordial ST-segment elevation in a 96-year-old woman with right coronary artery occlusion: A case report

Hao-Yu Wu  1 , Gong Cheng  1 , Yi-Wei Cao  2
Affiliations
Case Reports

Chest pain showing precordial ST-segment elevation in a 96-year-old woman with right coronary artery occlusion: A case report

Hao-Yu Wu et al. World J Clin Cases. .

Abstract

Background: Typically, right coronary artery (RCA) occlusion causes ST-segment elevation in inferior leads. However, it is rarely observed that RCA occlusion causes ST-segment elevation only in precordial leads. In general, an electrocardiogram is considered to be the most important method for determining the infarct-related artery, and recognizing this is helpful for timely discrimination of the culprit artery for reperfusion therapy. In this case, an elderly woman presented with chest pain showing dynamic changes in precordial ST-segment elevation with RCA occlusion.

Case summary: A 96-year-old woman presented with acute chest pain showing precordial ST-segment elevation with dynamic changes. Myocardial injury markers became positive. Coronary angiography indicated acute total occlusion of the proximal nondominant RCA, mild atherosclerosis of left anterior descending artery and 75% stenosis in the left circumflex coronary artery. Percutaneous coronary intervention was conducted for the RCA. Repeated manual thrombus aspiration was performed, and fresh thrombus was aspirated. A 2 mm × 15 mm balloon was used to dilate the RCA with an acceptable angiographic result. The patient's chest pain was relieved immediately. A postprocedural electrocardiogram showed alleviation of precordial ST-segment elevation. The diagnosis of acute isolated right ventricular infarction caused by proximal nondominant RCA occlusion was confirmed. Echocardiography indicated normal motion of the left ventricular anterior wall and interventricular septum (ejection fraction of 54%), and the right ventricle was slightly dilated. The patient was asymptomatic during the 9-mo follow-up period.

Conclusion: Cardiologists should be conscious that precordial ST-segment elevation may be caused by occlusion of the nondominant RCA.

Keywords: Case report; Chest pain; Electrocardiogram; Isolated right ventricular infarction; Precordial ST-segment elevation; Right coronary artery occlusion.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Twelve-lead electrocardiograms showed dynamic changes in precordial ST-segment elevation before coronary angiography. A: Electrocardiogram obtained on admission; B: Electrocardiogram obtained two hours after admission.
Figure 2
Figure 2
Coronary angiographic results. A: Acute total occlusion of the proximal portion of the right coronary artery (orange arrow); B: Mild atherosclerosis of the left anterior descending artery and 75% stenosis in the left circumflex artery; C: Fresh thrombus was acquired from the right coronary artery; D: Coronary angiography showed restoration of the right coronary artery after percutaneous coronary intervention.
Figure 3
Figure 3
Twelve-lead electrocardiograms showed alleviation of precordial ST-segment elevation after percutaneous coronary intervention. A: Electrocardiogram obtained fourteen hours after percutaneous coronary intervention; B: Electrocardiogram obtained 4 d after percutaneous coronary intervention.
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