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Pure right ventricular infarction.

Katsuji Inoue¹, Hiroshi Matsuoka, Hideo Kawakami

¹Department of Cardiology, Ehime Prefectural Imabari Hospital, Japan. katsu2@dokidoki.ne.jp

Circulation Journal : Official Journal of the Japanese Circulation Society

|May 10, 2002

Summary

This case study highlights pure right ventricular infarction, a condition mimicking anterior myocardial infarction due to right coronary artery occlusion. Early diagnosis is crucial for effective patient management.

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Area of Science:

Cardiology
Diagnostic Imaging
Interventional Cardiology

Background:

Acute myocardial infarction diagnosis typically relies on electrocardiography (ECG) and cardiac enzyme markers.
Anterior myocardial infarction is characterized by ST-segment elevation in specific ECG leads.
Right ventricular infarction can present with similar ECG findings, complicating diagnosis.

Observation:

A 76-year-old man presented with chest pain and ECG findings suggestive of acute anterior myocardial infarction.
Coronary angiography revealed ostial occlusion of a hypoplastic right coronary artery (RCA) with normal left coronary arteries.
Nuclear imaging confirmed infarction limited to the right ventricular free wall, with normal left ventricular function.

Findings:

The patient experienced ST-segment elevation in anterior and right precordial leads, mimicking anterior infarction.

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Despite ECG similarities, the infarction was isolated to the right ventricle due to ostial RCA occlusion.

Conservative management led to favorable clinical outcomes and symptom resolution.

Implications:

Pure right ventricular infarction should be considered in the differential diagnosis of ST-segment elevation myocardial infarction, especially with right precordial lead involvement.
Accurate diagnosis requires a combination of ECG, coronary angiography, and nuclear imaging.
Understanding this specific infarction pattern is vital for appropriate treatment strategies and prognosis.