Uncommon electrocardiographic presentation of an isolated right ventricular myocardial infarction

Isolated right ventricular myocardial infarction is an extremely rare condition, and its diagnosis may be challenging. We present the case of a 63-year-old man who arrived at the emergency department with chest pain; electrocardiogram showed ST-segment elevation in precordial leads, for which, the diagnosis of anterior ST-elevation myocardial infarction was initially made. Coronary angiography showed diffuse coronary artery ectasia and total thrombotic occlusion of the right coronary artery that was treated by angioplasty and stenting, resulting in resolution of the chest pain and ST-segment elevation. Echocardiogram showed right ventricular systolic dysfunction and cardiac magnetic resonance confirmed the diagnosis of isolated right ventricular myocardial infarction. We highlight the value of invasive and non-invasive tests to diagnose this rare condition. <Learning objective: Isolated right ventricular myocardial infarction is a very uncommon, but important differential diagnosis of anterior ST-elevation myocardial infarction. There exist certain electrocardiographic features favoring its diagnosis, although, recognition requires a high index of suspicion and support in different modalities of study including cardiac magnetic resonance and coronary angiography. Proper identification of it, will help to guide treatment and support for possible complications.>.