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A totally occluded right coronary artery presenting with a normal electrocardiogram

Vimal I Nanavati1, Andrew L Knapp, Susan Passelaqua

  • 1Comprehensive Cardiac Care, Inc., 1017 Butte Street, Redding, CA 96001, USA. tripleC@C-zone.net

The Journal of Invasive Cardiology
|June 5, 2003
PubMed

Insights

A patient with a totally blocked right coronary artery (RCA) had a normal electrocardiogram (ECG). Successful angioplasty restored blood flow, preventing a typical ST-elevation myocardial infarction.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diagnostic Electrocardiography

Background:

  • Total occlusion of the right coronary artery (RCA) typically presents with significant electrocardiogram (ECG) changes, indicating myocardial infarction.
  • ST-segment elevation in inferior leads is a common indicator of RCA occlusion.

Observation:

  • A case study involving a patient with a normal presenting ECG was analyzed.
  • Coronary angiography revealed a complete blockage in the proximal segment of the RCA.

Findings:

  • Emergency angioplasty and stenting successfully recanalized the occluded RCA, restoring TIMI III flow.
  • Post-procedure ECGs showed minimal changes, contrary to expectations for such a severe coronary occlusion.

Implications:

  • The findings suggest a potential protective role of the subendocardial microvascular network in mitigating myocardial damage.
  • This case highlights that a normal ECG does not always exclude severe coronary artery disease.
  • Further research into collateral circulation mechanisms could offer new therapeutic targets for myocardial infarction.

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