A case of unusual electrocardiographic presentation of right ventricular myocardial infarction

This is a case of an unusual electrocardiographic manifestation of a patient with right ventricular (RV) myocardial infarction occurring in association with left ventricular inferoposterior myocardial infarction. There was massive ST-segment elevation in the precordial leads resembling that of an anterior myocardial infarct in addition to the ST-segment elevation seen normally in right ventricular leads. Two-dimensional echocardiography confirmed right ventricular hypokinesia and coronary angiography revealed single-vessel coronary artery disease involving the right coronary artery. It served to remind us that the presence of diffuse and massive ST-segment elevation in the precordial leads in a patient with inferior myocardial infarction may indicate simultaneous RV infarction and warrants further confirmatory tests.