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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The presence of ST-segment elevation in the anterior precordial leads in patients with acute coronary syndromes usually indicates left anterior descending coronary artery occlusion&#46; However&#44; anterior ST-segment elevation has also been described in right coronary artery &#40;RCA&#41; occlusion and is thought to signify right ventricular myocardial infarction &#40;RVMI&#41;&#46; We describe a case of isolated RVMI presenting with anterior ST-segment elevation due to proximal occlusion of a right ventricular branch that was treated by primary angioplasty&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 61-year-old man with no history of cardiac disease presented to a community hospital reporting typical chest pain 3<span class="elsevierStyleHsp" style=""></span>hours in duration with more severe intensity in the last 30<span class="elsevierStyleHsp" style=""></span>minutes&#46; The initial standard 12-lead electrocardiogram &#40;ECG&#41; showed ST-segment elevation in leads V1&#8211;V5 and slight ST-segment elevation in the inferior leads &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; The patient was given 5000<span class="elsevierStyleHsp" style=""></span>U of unfractionated heparin IV&#44; 600<span class="elsevierStyleHsp" style=""></span>mg clopidogrel oral loading dose and 300<span class="elsevierStyleHsp" style=""></span>mg oral aspirin&#44; and was transferred to our hospital for urgent catheterization&#46; He arrived at our cath lab hemodynamically stable&#44; with persistent chest pain&#46; Coronary angiography&#44; performed four and a half hours after symptom onset&#44; showed a normal left coronary artery &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; and patent main vessel of the codominant RCA&#46; Left ventriculography was normal&#46; Careful review of the coronary angiogram revealed proximal occlusion of the right ventricular &#40;RV&#41; branch of the RCA &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A and B&#41;&#46; The RV branch occlusion was managed with balloon dilation and stenting &#40;2&#46;0<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>12&#46;0<span class="elsevierStyleHsp" style=""></span>mm bare-metal stent at 16<span class="elsevierStyleHsp" style=""></span>atm&#44; Multi-Link Mini Vision<span class="elsevierStyleSup">&#174;</span>&#44; Abbott Vascular&#44; USA&#41;&#44; resulting in resolution of the chest pain and ST-segment elevation &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1B and 3C</a>&#41;&#46; One hour after the procedure the patient experienced a new episode of chest discomfort and ST-segment changes similar to the initial ECG &#40;re-elevation in leads V1&#8211;V4 and slight elevation in leads II&#44; III&#44; and aVF&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; Emergency coronary angiography demonstrated acute stent thrombosis&#44; which was probably related to previous inadequate stent covering of the proximal portion of the coronary plaque&#46; Abciximab infusion was initiated&#44; thrombus aspiration was performed and another proximal and overlapped bare-metal stent &#40;2&#46;25<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>12&#46;0<span class="elsevierStyleHsp" style=""></span>mm at 12<span class="elsevierStyleHsp" style=""></span>atm&#44; Multi-Link Mini Vision<span class="elsevierStyleSup">&#174;</span>&#44; Abbott Vascular&#44; USA&#41; was implanted&#44; again resulting in resolution of chest pain and ST-segment elevation&#46; The peak troponin I level was 5&#46;2<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#46; The patient recovered without sequelae and was asymptomatic and fully active one month later&#46; Contrast-enhanced magnetic resonance imaging &#40;MRI&#41; performed 30 days after presentation showed normal left ventricular function and normal right ventricular size and motion&#46; No area of delayed hyperenhancement was visualized &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Isolated RVMI is uncommon&#44; with autopsy series indicating that it occurs in less than 3&#37; of all patients with myocardial infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It has been described essentially in two anatomical contexts&#58; occlusion of a nondominant RCA&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and loss of large RV branches during coronary angioplasty of the RCA&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There have been few reports of anterior ST-segment elevation caused by isolated RVMI due to RV branch occlusion in the absence of percutaneous coronary intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although it is usually considered that occlusion of a small nondominant right coronary artery is not associated with significant consequences&#44; there are reports of cases presenting with sudden cardiac death&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Importantly&#44; there are also reports of sudden cardiac death in which autopsy confirmed the occlusion of a branch of the RCA causing isolated RVMI&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Our case&#44; to the best of our knowledge&#44; is the first one reported of primary percutaneous coronary intervention treatment of an RV branch occlusion causing isolated acute RVMI and anterior ST-segment elevation&#46; Acute stent thrombosis with recurrence of chest pain and anterior ST-segment re-elevation was successfully managed percutaneously&#46; Revision of images of the first intervention showed that the proximal portion of the unstable coronary plaque was not covered by the stent&#46; Another stent was implanted&#44; proximal and overlapped to the previous one&#44; to cover all the unstable plaque&#46; Minimal myocardial necrosis was demonstrated by troponin assay and follow-up contrast-enhanced MRI showed no areas of delayed hyperenhancement in the right or left ventricles&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">When isolated RVMI occurs&#44; the ECG may show an acute anterior ST-segment elevation pattern &#40;leads V1 through V5&#41; and right ST-segment elevation &#40;leads V3R through V6R&#44; which were not performed in our case&#41;&#46; However&#44; isolated ST-segment elevation due to RVMI is uncommon in clinical practice&#46; Since RVMI usually occurs with simultaneous left ventricular inferior infarction&#44; the electrical current of injury from the left ventricle dominates the RV electrical forces&#46; The typical ECG changes in this setting are ST-segment elevation in the inferior leads with concomitant ST-segment depression in the precordial leads if the left ventricular posterior wall is involved&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Certain electrocardiographic features have been suggested which may help differentiate ST-segment elevation secondary to isolated RVMI from left anterior descending artery territory infarction&#46; However&#44; these features are not pathognomonic and it may be impossible to make this distinction on the basis of electrocardiography alone&#46; The absence of Q-wave development in the anterior precordial leads has been reported as favoring the diagnosis of RVMI&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> as was observed in our case&#46; Nevertheless&#44; other suggested features such as progressive reduction in ST-segment elevation across the precordial leads<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> were not seen in this case&#46; In addition&#44; an electrocardiographic criterion described by Lopez-Sendon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> in the differential diagnosis of RVMI and anteroseptal MI is the relationship between ST-segment elevation in V4R&#8211;V3&#46; In most patients with RVMI&#44; ST-segment elevation in V4R is higher than that found in V1&#8211;V3&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Our description clearly illustrates a case of isolated RVMI as an uncommon but important differential diagnosis of anterior ST-segment elevation and highlights the value of careful review of angiographic images&#44; as the culprit lesion may be an RV branch occlusion&#46; Primary percutaneous intervention of these branch vessels is possible and enables complete resolution of chest pain and ST-segment changes&#44; minimization of the damage to the RV myocardium&#44; and avoidance of malignant arrhythmias&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Case report
Isolated right ventricular infarction presenting with anterior ST-segment elevation: A case for careful assessment of right ventricular branch occlusion
Enfarte isolado do ventrículo direito simulando enfarte da parede anterior: atenção ao ramo ventricular direito!
Sérgio Nabais
Corresponding author
sergionnabais@gmail.com

Corresponding author.
, Victoria Martin-Yuste, Monica Masotti, Manel Sabaté
Interventional Cardiology Section, Cardiology Department, Thorax Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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    "titulo" => "Isolated right ventricular infarction presenting with anterior ST-segment elevation&#58; A case for careful assessment of right ventricular branch occlusion"
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        "titulo" => "Enfarte isolado do ventr&#237;culo direito simulando enfarte da parede anterior&#58; aten&#231;&#227;o ao ramo ventricular direito&#33;"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Right coronary angiogram &#40;A&#44; left anterior oblique view&#59; B&#44; right anterior oblique view&#41; demonstrating total occlusion of the right ventricular branch&#46; &#40;C&#41; Angiogram of the right coronary artery &#40;right anterior oblique view&#41; after stenting of the right ventricular branch with TIMI 3 flow&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The presence of ST-segment elevation in the anterior precordial leads in patients with acute coronary syndromes usually indicates left anterior descending coronary artery occlusion&#46; However&#44; anterior ST-segment elevation has also been described in right coronary artery &#40;RCA&#41; occlusion and is thought to signify right ventricular myocardial infarction &#40;RVMI&#41;&#46; We describe a case of isolated RVMI presenting with anterior ST-segment elevation due to proximal occlusion of a right ventricular branch that was treated by primary angioplasty&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 61-year-old man with no history of cardiac disease presented to a community hospital reporting typical chest pain 3<span class="elsevierStyleHsp" style=""></span>hours in duration with more severe intensity in the last 30<span class="elsevierStyleHsp" style=""></span>minutes&#46; The initial standard 12-lead electrocardiogram &#40;ECG&#41; showed ST-segment elevation in leads V1&#8211;V5 and slight ST-segment elevation in the inferior leads &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; The patient was given 5000<span class="elsevierStyleHsp" style=""></span>U of unfractionated heparin IV&#44; 600<span class="elsevierStyleHsp" style=""></span>mg clopidogrel oral loading dose and 300<span class="elsevierStyleHsp" style=""></span>mg oral aspirin&#44; and was transferred to our hospital for urgent catheterization&#46; He arrived at our cath lab hemodynamically stable&#44; with persistent chest pain&#46; Coronary angiography&#44; performed four and a half hours after symptom onset&#44; showed a normal left coronary artery &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; and patent main vessel of the codominant RCA&#46; Left ventriculography was normal&#46; Careful review of the coronary angiogram revealed proximal occlusion of the right ventricular &#40;RV&#41; branch of the RCA &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A and B&#41;&#46; The RV branch occlusion was managed with balloon dilation and stenting &#40;2&#46;0<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>12&#46;0<span class="elsevierStyleHsp" style=""></span>mm bare-metal stent at 16<span class="elsevierStyleHsp" style=""></span>atm&#44; Multi-Link Mini Vision<span class="elsevierStyleSup">&#174;</span>&#44; Abbott Vascular&#44; USA&#41;&#44; resulting in resolution of the chest pain and ST-segment elevation &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1B and 3C</a>&#41;&#46; One hour after the procedure the patient experienced a new episode of chest discomfort and ST-segment changes similar to the initial ECG &#40;re-elevation in leads V1&#8211;V4 and slight elevation in leads II&#44; III&#44; and aVF&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; Emergency coronary angiography demonstrated acute stent thrombosis&#44; which was probably related to previous inadequate stent covering of the proximal portion of the coronary plaque&#46; Abciximab infusion was initiated&#44; thrombus aspiration was performed and another proximal and overlapped bare-metal stent &#40;2&#46;25<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>12&#46;0<span class="elsevierStyleHsp" style=""></span>mm at 12<span class="elsevierStyleHsp" style=""></span>atm&#44; Multi-Link Mini Vision<span class="elsevierStyleSup">&#174;</span>&#44; Abbott Vascular&#44; USA&#41; was implanted&#44; again resulting in resolution of chest pain and ST-segment elevation&#46; The peak troponin I level was 5&#46;2<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#46; The patient recovered without sequelae and was asymptomatic and fully active one month later&#46; Contrast-enhanced magnetic resonance imaging &#40;MRI&#41; performed 30 days after presentation showed normal left ventricular function and normal right ventricular size and motion&#46; No area of delayed hyperenhancement was visualized &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Isolated RVMI is uncommon&#44; with autopsy series indicating that it occurs in less than 3&#37; of all patients with myocardial infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It has been described essentially in two anatomical contexts&#58; occlusion of a nondominant RCA&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and loss of large RV branches during coronary angioplasty of the RCA&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There have been few reports of anterior ST-segment elevation caused by isolated RVMI due to RV branch occlusion in the absence of percutaneous coronary intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although it is usually considered that occlusion of a small nondominant right coronary artery is not associated with significant consequences&#44; there are reports of cases presenting with sudden cardiac death&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Importantly&#44; there are also reports of sudden cardiac death in which autopsy confirmed the occlusion of a branch of the RCA causing isolated RVMI&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Our case&#44; to the best of our knowledge&#44; is the first one reported of primary percutaneous coronary intervention treatment of an RV branch occlusion causing isolated acute RVMI and anterior ST-segment elevation&#46; Acute stent thrombosis with recurrence of chest pain and anterior ST-segment re-elevation was successfully managed percutaneously&#46; Revision of images of the first intervention showed that the proximal portion of the unstable coronary plaque was not covered by the stent&#46; Another stent was implanted&#44; proximal and overlapped to the previous one&#44; to cover all the unstable plaque&#46; Minimal myocardial necrosis was demonstrated by troponin assay and follow-up contrast-enhanced MRI showed no areas of delayed hyperenhancement in the right or left ventricles&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">When isolated RVMI occurs&#44; the ECG may show an acute anterior ST-segment elevation pattern &#40;leads V1 through V5&#41; and right ST-segment elevation &#40;leads V3R through V6R&#44; which were not performed in our case&#41;&#46; However&#44; isolated ST-segment elevation due to RVMI is uncommon in clinical practice&#46; Since RVMI usually occurs with simultaneous left ventricular inferior infarction&#44; the electrical current of injury from the left ventricle dominates the RV electrical forces&#46; The typical ECG changes in this setting are ST-segment elevation in the inferior leads with concomitant ST-segment depression in the precordial leads if the left ventricular posterior wall is involved&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Certain electrocardiographic features have been suggested which may help differentiate ST-segment elevation secondary to isolated RVMI from left anterior descending artery territory infarction&#46; However&#44; these features are not pathognomonic and it may be impossible to make this distinction on the basis of electrocardiography alone&#46; The absence of Q-wave development in the anterior precordial leads has been reported as favoring the diagnosis of RVMI&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> as was observed in our case&#46; Nevertheless&#44; other suggested features such as progressive reduction in ST-segment elevation across the precordial leads<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> were not seen in this case&#46; In addition&#44; an electrocardiographic criterion described by Lopez-Sendon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> in the differential diagnosis of RVMI and anteroseptal MI is the relationship between ST-segment elevation in V4R&#8211;V3&#46; In most patients with RVMI&#44; ST-segment elevation in V4R is higher than that found in V1&#8211;V3&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Our description clearly illustrates a case of isolated RVMI as an uncommon but important differential diagnosis of anterior ST-segment elevation and highlights the value of careful review of angiographic images&#44; as the culprit lesion may be an RV branch occlusion&#46; Primary percutaneous intervention of these branch vessels is possible and enables complete resolution of chest pain and ST-segment changes&#44; minimization of the damage to the RV myocardium&#44; and avoidance of malignant arrhythmias&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We describe the case of a 61-year-old man who presented with chest pain and ST-segment elevation in the anterior precordial leads &#40;V1&#8211;V5&#41; due to proximal occlusion of the right ventricular branch of a codominant right coronary artery&#46; Primary coronary angioplasty and stenting of this branch was performed resulting in resolution of the chest pain and ST-segment elevation&#46; Our description illustrates a case of isolated right ventricular infarction as an uncommon but important differential diagnosis of anterior ST-segment elevation&#46; In addition&#44; it highlights the value of careful review of the angiographic images in this context&#44; as the culprit lesion may be a right ventricular branch occlusion&#46; To the best of our knowledge&#44; this is the first reported case of primary percutaneous coronary intervention treatment of a right ventricular branch occlusion causing isolated acute right ventricular myocardial infarction and anterior ST-segment elevation&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descreve-se o caso de um homem de 61 anos que se apresentou com dor tor&#225;cica t&#237;pica e supradesnivelamento do segmento ST nas deriva&#231;&#245;es precordiais &#40;V1-V5&#41;&#46; A coronariografia de urg&#234;ncia revelou a oclus&#227;o proximal de um ramo ventricular da art&#233;ria coron&#225;ria direita&#46; Foi realizada angioplastia prim&#225;ria deste ramo com implanta&#231;&#227;o de <span class="elsevierStyleItalic">stent</span> met&#225;lico convencional&#44; resultando na resolu&#231;&#227;o da dor tor&#225;cica e da eleva&#231;&#227;o ST&#46; A presente descri&#231;&#227;o ilustra um caso de enfarte isolado do ventr&#237;culo direito como um diagn&#243;stico diferencial pouco comum mas importante de eleva&#231;&#227;o ST nas deriva&#231;&#245;es precordiais&#46; O presente caso real&#231;a ainda a import&#226;ncia de uma cuidadosa revis&#227;o das imagens angiogr&#225;ficas neste contexto&#44; uma vez que a les&#227;o culpada pode ser a oclus&#227;o de um ramo ventricular direito&#46; Segundo a nossa pesquisa&#44; o presente caso trata-se da primeira descri&#231;&#227;o de interven&#231;&#227;o coron&#225;ria percut&#226;nea prim&#225;ria de um ramo ventricular direito causando enfarte isolado do ventr&#237;culo directo e eleva&#231;&#227;o ST nas deriva&#231;&#245;es precordiais&#46;</p>"
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                          "autores" => array:3 [
                            0 => "S&#46; Gregory"
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                      "titulo" => "Isolated right ventricular infarction &#8211; an uncommon cause of acute anterior ST segment elevation"
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                            2 => "V&#46; Mathew"
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                      "doi" => "10.1016/j.ijcard.2007.08.017"
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Revista Portuguesa de Cardiologia (English edition)
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