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Challenges in Clinical Electrocardiography
August 2016

Isolated Right Ventricular Myocardial Infarction: A Sheep in Wolf’s Clothing

Author Affiliations
  • 1Division of Cardiology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
  • 2Division of Cardiology, Department of Medicine, Queen’s University, Kingston, ON, Canada
JAMA Intern Med. 2016;176(8):1207-1210. doi:10.1001/jamainternmed.2016.3085

Anterior ST segment elevation is typically associated with left ventricular anterior myocardial infarction. However, in rare cases, this electrocardiogram (ECG) pattern is due to isolated infarction of the right ventricle. Here, we present 2 sequential cases of isolated right ventricular myocardial infarction due to right ventricular branch occlusion.

A 51-year-old man presented with acute-onset chest discomfort. The ECG showed convex up ST segment elevation (STE) of leads V1 through V3 with no inferior reciprocal changes (Figure 1A). Emergency cardiac catheterization was arranged for a suspected left anterior descending artery (LAD) occlusion. However, coronary angiography showed only minor luminal irregularities in the LAD and left circumflex artery. Only a nonobstructive, 40% proximal right coronary artery (RCA) stenosis was noted. The left ventriculogram was normal (Video 1). The patient was transferred to the coronary care unit where he continued to have ongoing chest pain. A computed tomographic pulmonary angiogram showed no evidence of pulmonary embolism.

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