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The first appearance deceives many: Isolated RV infarct masquerading as an anterior STEMI

Umar Ismail1, Olga Toleva1, Davinder S Jassal1,2

  • 1Section of Cardiology Department of Internal Medicine Max Rady College of Medicine Rady Faculty of Health Sciences University of Manitoba Winnipeg MB Canada.

Clinical Case Reports
|October 22, 2020
PubMed

Insights

ST-segment elevation in precordial EKG leads typically indicates left anterior descending artery occlusion. However, this pattern can also signify isolated right ventricular infarction, a crucial distinction for patient care.

Area of Science:

  • Cardiology
  • Electrocardiography
  • Myocardial Infarction

Background:

  • ST-segment elevation in precordial leads (V1-V6) on an electrocardiogram (EKG) is commonly associated with occlusion of the left anterior descending (LAD) artery.
  • This EKG finding often prompts immediate intervention for anterior ST-elevation myocardial infarction (STEMI).

Purpose of the Study:

  • To investigate the diagnostic utility of precordial ST-segment elevation in identifying isolated right ventricular (RV) infarction.
  • To differentiate RV infarction from LAD artery occlusion based on EKG patterns.

Main Methods:

  • Retrospective analysis of EKG findings in patients diagnosed with RV infarction.
  • Comparison of EKG characteristics between patients with RV infarction and those with LAD occlusion.

Main Results:

  • Isolated right ventricular infarction can present with ST-segment elevation in precordial leads, mimicking LAD occlusion.
  • Specific EKG criteria may help differentiate these two conditions, though overlap exists.

Conclusions:

  • Precordial ST-segment elevation is not pathognomonic for LAD occlusion and should prompt consideration of isolated RV infarction.
  • Accurate differentiation is vital for appropriate therapeutic strategies and improved patient outcomes in myocardial infarction.

Keywords:
EKGmyocardial infarctionright ventricle

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