ST Elevation in Leads V1 to V4 Caused by Isolated Right Ventricular Ischemia and Infarction

Abstract

A patient with isolated right ventricular ischemia and infarction is presented. ST elevation in leads V1 to V4 mimicking anteroseptal myocardial infarction was recorded at admission and during episodes of chest pain later on. Noninvasive and invasive workup suggested isolated right ventricular infarction and ischemia due to an occluded small and nondominant right coronary artery.

Acute Thrombotic Occlusion of Non-Dominant Right Coronary Artery Presenting as Acute Coronary Syndrome and Hemodynamic Instability

“…Electrocardiogram can mimic Inferior wall or anterior wall ischemia and infarction. Anterior ST elevation mimicking anterior wall MI has been described in thrombotic occlusion of NDRCA by vural et al [3] , Carrol et al [5] , Franco et al [6] , Collins et al [7] and Ilia et al [8] . Moreyra et al reported ST elevation in both anterior and inferior leads [1] .…”

Isolated Nondominant Right Coronary Stenosis

“…Interestingly, despite our experience with primary PCI (we were the first to adopt this procedure in our country in 1993 for all patients with STEMI), no patient presenting with isolated RV infarction due to an acute occlusion of NDRCA was found in our series. This may be attributed to the rare ST elevation changes in a standard 12-lead electrocardiogram (ECG) [7][8][9] usually performed in a primary care or emergency room setting on initial presentation of the patient. If RV leads had been included in the ECG performed, we would have expected to see some cases of acute ST elevation RV infarction.…”