Letter to the Editor
Isolated right ventricular infarction — An uncommon cause of acute anterior ST segment elevation

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Abstract

We describe a case of isolated right ventricular myocardial infarction as the cause of anterior precordial lead ST segment elevation. This case illustrates that anterior ST segment elevation may occur with occlusion of the right coronary artery. It is important to recognize this scenario as the treatment of right ventricular myocardial infarction differs from that of left ventricular myocardial infarction.

Introduction

The findings of ST segment elevation on an electrocardiogram (ECG) must be interpreted in the context of the clinical presentation. It may be benign and a normal variant in individuals with early repolarization or a manifestation of a chronic process such as hypertension with left ventricular hypertrophy associated with abnormal repolarization. Alternatively, acute onset of ST segment elevation may represent pericardial inflammation but most often, in patients with chest pain, it is secondary to acute myocardial injury or ischemia. There is increasing focus on developing strategies for rapid diagnosis and treatment of patients with ST segment elevation myocardial infarction. As such, accurate interpretation of the ECG is critical. Anterior ST segment elevation myocardial infarction is most often due to occlusion of the left anterior descending artery. We describe a patient who presented with symptoms of an acute coronary syndrome and anterior ST segment elevation due to isolated right ventricular myocardial infarction, an uncommon and underrecognized cause of anterior ST segment elevation.

Section snippets

Case report

A 62 year old male with multiple risk factors for coronary artery disease underwent coronary angiography following a markedly positive exercise echocardiogram. The angiogram demonstrated a severe, proximal right coronary artery (RCA) stenosis (Fig. 1A). Successful stenting of the vessel was performed without complications (Fig. 1B). A routine post intervention ECG was normal (Fig. 2A). Six hours following the procedure, the patient complained of nausea and diaphoresis. A repeat ECG showed new

Discussion

While anterior ST segment elevation is classically the hallmark finding of a myocardial infarction (MI) involving the LAD, our case demonstrates that anterior ST segment elevation can be the result of an isolated acute right ventricular myocardial infarction (RVMI). Animal experiments have demonstrated that anterior precordial ST segment elevation can be the result of isolated RVMI [1]. However, isolated ST segment elevation due to RVMI is uncommon in clinical practice. The rationale for the

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