Anterior ST-Segment Elevation From Nondominant Right Coronary Artery Occlusion: Lessons From Two Cases
Hadeel Ayesh1, Mohammad Al-Shaer1, Shoukri Alsleibi1
1Department of Cardiology, Bethlehem Arab Society for Rehabilitation, Bethlehem, State of Palestine.
Abstract:
Acute occlusion of a nondominant right coronary artery (RCA) is an uncommon but clinically significant cause of anterior ST-segment elevation that may mimic anterior ST-segment elevation myocardial infarction (STEMI) and pose a diagnostic challenge in identifying the culprit vessel during emergent coronary angiography. We report two patients presenting with anterior ST-segment elevation in whom emergent coronary angiography revealed acute occlusion of a nondominant RCA with right ventricular branch compromise. In both cases, chest pain and ST-segment elevation improved immediately after RCA reperfusion and before intervention on other coronary lesions. These cases highlight the importance of recognizing this atypical presentation and carefully assessing coronary anatomy to identify the culprit vessel and guide timely revascularization.
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