Isolated right ventricular infarction is an extremely rare phenomenon. Its electrocardiographic (ECG) features may be misinterpreted or even missed if not suspected. A case of an isolated right ventricular myocardial infarction is presented, recognized by ST-segment elevation in a single precordial lead, such as V1, aided thereafter by right precordial ECG changes. Immediate coronary angiography revealed proximal occlusion of a small non-dominant right coronary artery. Coronary intervention as well as infusion of intravenous normal saline solution and pressor agent for hypotension provided symptomatic relief, and subsequent recovery from this potentially life-threatening, but rare condition. Routine 12-lead ECG done approximately 12 hours after the admission showed extension of ST segment elevation from V1 trough V3 without any ST-segment elevation in inferior leads. This case demonstrates that there might be a very unusual ECG appearance in the setting of an isolated right ventricular myocardial infarction and can be missed if not immediately suspected. Isolated right ventricular myocardial infarction may be difficult to recognize, requiring both a high index of clinical suspicion for its presence, as well as careful evaluation of unusual ECG features of the disease entity.

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