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[Marked ST-segment elevation in the precordial and inferior leads in right ventricular myocardial infarction: a case
H Kataoka1, K Kanzaki, Y Mikuriya
1Second Department of Internal Medicine, Oita Medical College.
Insights
This case report details a rare instance of right ventricular infarction with inferior myocardial infarction, showing significant ST-segment elevation in precordial and inferior leads. This presentation highlights unusual electrocardiogram findings in complex cardiac events.
Area of Science:
- Cardiology
- Diagnostic Electrocardiography
Background:
- Right ventricular infarction (RVI) can present with ST-segment elevation.
- Precordial ST-segment elevation is an atypical finding in RVI.
Observation:
- A 51-year-old male presented with chest pain and significant ST-segment elevation in precordial (V2) and inferior (II) leads.
- Echocardiography revealed right ventricular free wall akinesis and posterior left ventricular dysfunction.
- Coronary angiography showed a 90% proximal right coronary artery stenosis.
Findings:
- The case demonstrates marked ST-segment elevation in both precordial and inferior leads, a previously unreported phenomenon in RVI.
- This suggests simultaneous injury currents in the right ventricular free wall and left ventricular inferior wall.
Implications:
- This case expands the understanding of electrocardiogram manifestations in complex myocardial infarction.
- Clinicians should consider RVI in cases with unusual ST-segment elevation patterns.
Abstract:
This is a report of right ventricular infarction complicated by inferior myocardial infarction in which marked ST-segment elevation was observed in the precordial and inferior leads. A 51-year-old man was admitted with chest pain of one-half hour duration. His admission ECG showed conspicuous ST-segment elevation in the precordial and inferior leads. The maximum magnitude of the ST-segment elevation in the precordial leads was 21 mm in lead V2 and 10 mm in lead II. Echocardiography showed akinesis of the right ventricular free wall and the posterior half of the left ventricle. Angiography revealed a 90% reduction in the diameter of the right coronary artery in its proximal portion, and a normal left coronary system. Recent reports have indicated that precordial ST-segment elevation may reflect right ventricular infarction. However, there has been no previous report of marked ST-segment elevation in the precordial and inferior leads. In right ventricular infarction, the currents of injury usually occur simultaneously in the right ventricular free wall and left ventricular inferior wall, and then are electrically opposed to each other. The diffuse and marked ST-segment elevation observed in this case is thus a rare phenomenon.