Korean Circ J.  2008 Sep;38(9):495-499. 10.4070/kcj.2008.38.9.495.

Precordial ST-Segment Elevation in Acute Right Ventricular Myocardial Infarction

• Ryou NS
• Cho MH
• Shin DH
• Cheong SS
• Yoo SY

• KMID: 1776351
• DOI: http://doi.org/10.4070/kcj.2008.38.9.495

Abstract

It is rare to observe ST-segment elevations in the precordial leads that are caused by an occlusion of the right coronary artery and/or its branches. We report here on two cases of acute occlusion of the right coronary artery or its branches that caused acute right ventricular myocardial infarction with ST-segment elevations in the anterior precordial leads. These cases should remind us that the presence of diffuse ST-segment elevations in the precordial leads could be due to acute occlusion of the right coronary artery.

Keyword

Myocardial infarction; Right ventricle; Electrocardiography

MeSH Terms

Coronary Vessels
Electrocardiography
Heart Ventricles
Myocardial Infarction

Figure

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  Fig. 1 Electrocardiography (ECG) and diagnostic coronary angiography findings on admission. A: the electrocardiography on admission showed normal sinus rhythm and no significant ischemic ST-segment deviations. B and C: the initial coronary angiography showed significant luminal narrowing at the proximal segments of the left anterior descending artery and the right coronary artery (arrows), and an open right ventricular side branch with normal distal flow (arrowhead).

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  Fig. 2 Electrocardiography (ECG) and coronary angiography findings after percutaneous coronary intervention (PCI). A: the electrocardiography immediately after percutaneous coronary intervention showed marked ST-segment elevations in the precordial leads. B and C: repeated coronary angiography showed that the left anterior descending artery and the stented area were open with normal coronary flow (arrow), but the right ventricular branch was stent-jailed (arrowhead).

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  Fig. 3 Electrocardiography (ECG) and diagnostic coronary angiography findings on admission. A: the initial electrocardiography on admission showed atrio-ventricular block and marked ST-segment elevations in both the inferior and precordial leads and 1 mm ST-segment elevations from V4R to V6R. B: the initial coronary angiography revealed no significant luminal narrowing of the left coronary arteries. C: note the total occlusion at the proximal segment of the right coronary artery with TIMI 0 flow (arrowhead). TIMI: Thrombolysis In Myocardial Infarction.

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  Fig. 4 Electrocardiography (ECG), coronary angiography, and transesophagreal echocardiography (TEE) findings after percutaneous coronary intervention (PCI). A: the electrocardiography after percutaneous coronary intervention showed resolution of the ST-segment elevation in the precordial leads. B: the coronary angiography, following percutaneous coronary intervention, showed a good appearance with TIMI 3 flow (arrows). C: the transesophageal echocardiography revealed the secundum type of atrial septal defect with left to right shunt. LA: left atrium, RA: right atrium, TIMI: Thrombolysis In Myocardial Infarction.

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