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[ST segment elevation in anterior precordial leads and right ventricular infarction. Apropos of 6 cases]
G Grollier1, P Scanu, M Gofard
1Service de soins intensifs de cardiologie, CHU Côte de Nacre, Caen.
Insights
Right ventricular infarction can present with ST segment elevation in anterior chest leads, mimicking left ventricular anterior wall infarction. Echocardiography aids in rapid diagnosis by showing normal left ventricular size.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Electrocardiography
Context:
- Right ventricular infarction (RVI) diagnosis can be challenging.
- ST segment elevation in anterior precordial leads (V1-V3) is typically associated with left ventricular anterior myocardial infarction.
- RVI may present with similar electrocardiographic findings, potentially leading to misdiagnosis.
Purpose:
- To identify electrocardiographic (ECG) patterns suggestive of right ventricular infarction.
- To differentiate RVI from left ventricular anterior wall infarction based on ECG and echocardiographic findings.
- To report the incidence and coronary artery culprits in patients with RVI presenting with anterior ST elevation.
Summary:
- Six out of 700 patients experienced RVI with anterior precordial ST segment elevation.
- Isolated RVI was linked to right marginal or small right coronary artery occlusion.
- Associated left ventricular inferior wall infarction occurred in two cases.
- Specific ECG features like dome-like ST elevation, decreasing amplitude from V2 to V5, and regression without Q waves suggest RVI.
- Echocardiography showing normal left ventricular dimensions aids in confirming RVI.
Impact:
- Highlights the importance of considering RVI in patients with anterior ST elevation, especially when inferior leads are normal.
- Provides specific ECG criteria to aid in differentiating RVI from LV anterior MI.
- Emphasizes the role of echocardiography in the rapid and accurate diagnosis of RVI.
- Contributes to understanding the coronary artery anatomy involved in RVI.
Abstract:
ST segment elevation in the anterior precordial chest leads may be observed in some cases of right ventricular infarction alone or associated with left ventricular inferior wall infarction. Six out of 700 patients admitted to our Coronary Care Unit over a 2 year period had right ventricular infarction with these electrocardiographic changes. In three cases, isolated right ventricular infarction was due to occlusion of a right marginal artery (N = 2) or of a small right coronary artery (N = 1) which only vascularised the right ventricle. In 2 cases, right ventricular infarction was associated with a recent or chronic left ventricular inferior wall infarct. This type of ST segment elevation may suggest a left ventricular anterior wall infarct especially when there are no changes in the inferior leads, as was the case in our first patient. However, the dome-like appearance of the ST segment, the reduction in amplitude of ST elevation from V2 to V5, the progressive regression of the ST changes without the appearance of Q waves, are more suggestive of the diagnosis of right ventricular infarction. In addition, normal left ventricular dilatation on echocardiographic examination rapidly confirms the diagnosis.