Proximal RCA occlusion producing anterior ST segment elevation, Q waves, and T wave inversion

Area of Science:

• Cardiology
• Medical Diagnostics
• Electrocardiography

Background:

• ST segment elevation myocardial infarction (STEMI) with anterior ST segment elevation (STE) is typically attributed to left anterior descending (LAD) artery occlusion.
• Anterior STE can also arise from occlusion of the proximal right coronary artery (RCA) or its right ventricular marginal branch (RVB).
• Previous understanding suggested proximal RCA/RVB occlusion rarely leads to Q waves in right precordial leads, unlike LAD occlusions.

Observation:

• This report details a unique case of anterior STE.
• The observed STE was associated with anterior T wave inversions and anterior Q waves.
• These electrocardiographic changes were linked to a proximal RCA occlusion.

Findings:

• Proximal right coronary artery (RCA) occlusion can manifest with anterior ST segment elevation (STE).
• Contrary to prior beliefs, proximal RCA occlusion may produce anterior T wave inversions and anterior Q waves.
• This challenges the diagnostic exclusivity of LAD occlusion for anterior STE with Q waves.

Implications:

• Clinicians should consider proximal RCA occlusion in cases of anterior STE, even with Q waves.
• Electrocardiographic interpretation of anterior STEMI requires awareness of atypical presentations.
• This finding may refine diagnostic criteria and improve patient outcomes for myocardial infarction.