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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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Proximal complete occlusion of right coronary artery presenting with precordial ST-segment elevation: A case report

Jianlei Zheng1, Jingyang Lin, Naiji Shen

  • 1Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou, China.

Medicine
|October 15, 2016
PubMed

Insights

Diagnosing the cause of ST-segment elevation myocardial infarction (STEMI) can be challenging. This case highlights how right coronary artery occlusion can mimic left anterior descending artery issues, emphasizing the need for comprehensive diagnostic tools.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diagnostic Imaging

Background:

  • Acute ST-segment elevation myocardial infarction (STEMI) diagnosis typically relies on electrocardiogram (ECG) findings.
  • Left anterior descending (LAD) artery occlusion is the most common cause of ST-segment elevation in precordial leads.
  • Rarely, proximal right coronary artery (RCA) or right ventricular (RV) branch occlusion can also present with ST-segment elevation in V1-V3.

Observation:

  • A patient presented with acute chest pain and ventricular fibrillation (VF).
  • ECG revealed ST-segment elevation in leads V1-V3 and V4R.
  • Bedside echocardiography showed normal left ventricular ejection fraction and mild RV dilation.

Findings:

  • Coronary angiography confirmed proximal occlusion of a nondominant RCA.
  • Urgent percutaneous coronary intervention (PCI) to the RCA resolved chest pain and ECG abnormalities.
  • This case demonstrates RCA occlusion presenting similarly to LAD occlusion.

Implications:

  • Coronary angiography remains the gold standard for culprit lesion identification.
  • Bedside echocardiography, specific ECG ST-segment changes (left and right precordial leads), and heart rate provide valuable supplementary diagnostic information.
  • These additional data points can aid in differentiating RCA from LAD occlusions presenting with ST-segment elevation in precordial leads.
Abstract

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