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Case report: isolated right coronary artery obstruction presenting as acute anterior myocardial infarction
1Department of Cardiology, Coney Island Hospital, Brooklyn, NY 11235.
Insights
Acute myocardial infarction (MI) can present atypically. This case highlights how right ventricular MI may mimic anterior MI on ECG, necessitating careful diagnostic differentiation for appropriate treatment.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Interventional Cardiology
Background:
- Electrocardiogram (ECG) changes, specifically S-T segment elevation in anterior leads, are typically indicative of acute anterior myocardial infarction (MI).
- Right ventricular myocardial infarction (RVMI) is a recognized clinical entity that can present with varied ECG findings.
Observation:
- A patient presented with chest pain and anterior ECG changes suggestive of acute anterior MI.
- Non-invasive imaging revealed no anterior MI but confirmed right ventricular MI.
- Coronary angiography identified an isolated obstruction in the right coronary artery.
Findings:
- The ECG findings in acute right ventricular MI can occasionally resemble those of an anterior MI.
- Diagnostic imaging and coronary angiography are crucial for differentiating RVMI from anterior MI when ECG is ambiguous.
Implications:
- Accurate differentiation between anterior MI and RVMI is critical for guiding therapeutic strategies.
- Misdiagnosis can lead to suboptimal or incorrect treatment, impacting patient outcomes.
- This case underscores the importance of considering RVMI in the differential diagnosis of anterior ST-segment elevation MI.
Abstract:
A patient presented with chest pain and S-T segment elevation in the anterior chest leads diagnostic of acute anterior myocardial infarction (MI). The non-invasive imaging studies showed no evidence of left ventricular anterior MI but showed a right ventricular MI. Coronary angiography showed an isolated right coronary artery obstruction. Occasionally, the ECG in acute right ventricular myocardial infarction may resemble an anterior MI. The differentiation is important from a therapeutic viewpoint.