Introduction. Electrocardiography is an initial non-invasive diagnostic
algorithm for ST elevation acute myocardial infarction. Specific
electrocardiographic phenomenon is described, when the occlusion of the
proximal segment of the right coronary artery or the isolated occlusion of
its ventricular branch is presented with ST elevation in the precordial
leads. Case Report. A 78-year-old woman was admitted as an emergency due to
chest pain and electrocardiographically recorded concave elevation in leads
V1 - V3. She was diagnosed with ST elevation myocardial infarction of the
anterior region and sent to catheterization laboratory for emergency
coronary angiography. It showed an occlusion of the proximal-medial right
coronary artery. Behind the occlusion, the right coronary artery, posterior
descending artery and posterior lateral artery, a hetero-collateral
circulation was seen. Two drug-eluting stents were implanted into the
proximal segment of the right coronary artery. Discussion. The phenomenon of
acute myocardial infarction caused by occlusion of the proximal right
coronary artery and/or ventricular branches of the right coronary artery,
presenting with ST segment elevation in the precordial leads, is a
consequence of several anatomical variations: occlusion of nondominant right
coronary artery, isolated occlusion of the ventricular branch of the right
coronary artery, and the occlusion of the right coronary artery proximal to
the ventricular branch with hetero collateral circulation on the periphery
of the right coronary artery, like in our case. Electrocardiographic
characteristic pointing to the occlusion of the proximal right coronary
artery and/or ventricular branches of the right coronary artery is higher ST
elevation in the lead V1 than in the other leads, followed by the absence of
Q wave development. This ST elevation is concave. Conclusion. It is
necessary to emphasize the significance of differential diagnosis of culprit
lesion in patients with chest pain and elevation of the ST segment in the
precordial leads having in mind further different thera peutic algorithms.
Patients with right ventricular myo cardial infarction need to maintain an
adequate ?preload? and avoid vasodilators in order to maintain the right
ventricular stroke volume.
Incidental, non-gated thoracic CT angiographic detection of proximal right coronary artery total occlusion associated with acute myocardial infarction
