Proximal complete occlusion of right coronary artery presenting with precordial ST-segment elevation

Zheng, Jianlei; Lin, Jingyang; Shen, Naiji; Qu, Baiming

doi:10.1097/md.0000000000005113

Cited by 10 publications

(6 citation statements)

References 19 publications

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“…The second main pattern is STE in anterior leads. This ECG pattern includes decreasing STE from V 1 /V 2 to V 4 /V 5 with no apparent Q waves and no reciprocal STD in inferior leads . When IRVMI leads to RV enlargement, there will be clockwise transposition of the heart, resulting in STE in anterior leads.…”

Section: Discussionmentioning

confidence: 99%

“…This ECG pattern includes decreasing STE from V 1 /V 2 to V 4 /V 5 with no apparent Q waves and no reciprocal STD in inferior leads. 5,6 When IRVMI leads to RV enlargement, there will be clockwise transposition of the heart, resulting in STE in anterior leads. Because V 1 is located directly over the RV, STE in V 1 is greater than that in V 2 and V 3 .…”

Section: Challenges In Clinical Electrocardiographymentioning

confidence: 99%

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Diagnostic Traps—Noteworthy Electrocardiogram Patterns

2022

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Section: Discussionmentioning

confidence: 99%

Section: Challenges In Clinical Electrocardiographymentioning

confidence: 99%

Diagnostic Traps—Noteworthy Electrocardiogram Patterns

2022

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“…In addition, the absence of inferior STE has been shown to support the diagnosis of isolated acute RV myocardial infarction. 6 Acute anterior STE typically suggests occlusion of the LAD. Electrocardiographic criteria have been used to differentiate an acute occlusion of the LAD from an occlusion of the RV marginal branch.…”

Section: Discussionmentioning

confidence: 99%

Acute Isolated Right Ventricular Infarction: Unusual Presentation of Anterior ST-Segment-Elevation Myocardial Infarction

Zhong¹,

Blue²,

Michaels³

2019

Texas Heart Institute Journal

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Acute right ventricular infarction presenting with ST-segment elevation in the anterior precordial electrocardiographic leads is an unusual event. Anterior ST-segment elevation typically suggests occlusion of the left anterior descending coronary artery. It should be recognized, however, that occlusion of a right coronary artery branch can cause isolated ST-segment elevation in leads V 1 and V 2 on a standard 12-lead electrocardiogram. We describe the cases of 2 patients who presented with acute chest syndrome with isolated ST-segment elevation in leads V 1 and V 2 . Emergency coronary angiograms revealed that acute thrombotic occlusion of the right ventricular marginal branch of the dominant right coronary artery caused the clinical manifestations in the first patient, whereas occlusion of the proximal nondominant right coronary artery was the culprit lesion in the second patient. Both lesions caused right ventricular myocardial infarction. The patients underwent successful primary percutaneous coronary intervention. These cases illustrate the importance of carefully reviewing angiographic findings to accurately diagnose an acute isolated right ventricular myocardial infarction, which may mimic the electrocardiographic features of an anterior-wall myocardial infarction. (Tex Heart Inst J 2019;46(2):151-4)S T-segment elevation (STE) in precordial electrocardiographic (ECG) leads V 1 and V 2 typically indicates occlusion of the left anterior descending coronary artery (LAD). However, in rare cases, isolated STE in these leads has been associated with acute right ventricular (RV) marginal branch occlusion, 1-7 because leads V 1 and V 2 lie directly over the RV.We describe the cases of 2 patients who presented with acute STE in leads V 1 and V 2 caused by occlusion, involving the RV marginal branch of the dominant right coronary artery (RCA) in the first case and the proximal nondominant RCA in the second case. The patients were treated by means of primary percutaneous coronary intervention (PCI). These cases highlight the importance of considering an RCA occlusion as a potential cause of isolated RV myocardial infarction when ECG features suggest an acute anterior-wall STE myocardial infarction (STEMI). Recognizing this pattern in patients with acute STEMI can help to identify the culprit arteries for timely initiation of reperfusion therapy. Case Reports Patient 1In December 2016, a 52-year-old obese man presented at our hospital with a 90-minute history of acute left-sided neck and upper chest pain. Standard 12-lead ECG showed STE in leads V 1 and V 2 (Fig. 1). Emergency coronary artery angiograms revealed a smooth, nonthrombotic mid-LAD stenosis of intermediate severity (70%), an anomalous origin of the left circumflex coronary artery from the proximal RCA, nonobstructive atherosclerotic plaque in the dominant RCA, and acute thrombotic occlusion of the proximal RV branch (Fig. 2).We used a 2 × 23-mm bare-metal MultiLink Vision ® coronary stent (Abbott Vascular) to treat the proximal RV branch occlusion and achie...

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“…One should also note that in this study RV function was not evaluated and we could only infer it to be worse in patients with RCA occlusion because of the greater magnitude of RV branches from this vessel. Zheng et al [ 9 ] have selected some aspects that would suggest RCA occlusion/RVMI when precordial ST elevation is present: decreasing magnitude of ST segment elevation from V1 to V3, convex ST elevation, concomitant sinus node dysfunction, and V3-V4R ST elevation. Also, the authors suggest a complementary bedside evaluation with echocardiography in which RV dilation would add to the electrocardiogram approach.…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction Caused by an Anomalous Right Coronary Artery Occlusion Presenting with Precordial ST Elevation

Matte¹,

Azmus²

2017

Case Reports in Cardiology

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Acute coronary syndrome with precordial ST segment elevation is usually related to left anterior descending artery occlusion, although isolated right ventricular infarction has been described as a cause of ST elevation in V1–V3 leads. We present a case of a patient with previous inferior wall infarction and new acute ST elevation myocardial infarction (STEMI) due to proximal right coronary thrombotic occlusion resulting in right ventricular infarction with precordial ST elevation and sinus node dysfunction. The patient was treated with successful rescue angioplasty achieving resolution of acute symptoms and electrocardiographic abnormalities.

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Proximal complete occlusion of right coronary artery presenting with precordial ST-segment elevation

Cited by 10 publications

References 19 publications

Diagnostic Traps—Noteworthy Electrocardiogram Patterns

Diagnostic Traps—Noteworthy Electrocardiogram Patterns

Acute Isolated Right Ventricular Infarction: Unusual Presentation of Anterior ST-Segment-Elevation Myocardial Infarction

Acute Myocardial Infarction Caused by an Anomalous Right Coronary Artery Occlusion Presenting with Precordial ST Elevation

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