Félix-Bulman JA, Amador-Mena JE, Macías-Garrido E

Language: English
References: 12
Page: 200-205
PDF size: 321.88 Kb.

ABSTRACT

Introduction: In some cases, ST segment elevation in right precordial leads in conjunction with inferior leads can be originated by an obstruction of the right coronary artery in its proximal portion, generating an inferior myocardial infarction which involves the right ventricle. Case presentation: We present the case of a 57-year-old male, which presents symptoms of acute coronary syndrome. The electrocardiogram shows subepicardial injury in anteroseptal leads (V1-V3) and elevation of ST segment in inferior leads (DIII, AVF). A coronariography is performed finding a complete obstruction of right coronary artery in the proximal portion, left coronary artery without lesions. Analysis: In right ventricular infarction or anteroseptal infarction, the ST segment vector always has a posterior- anterior direction in horizontal plane, the direction of this vector will produce an elevation of ST segment in leads V1 to V3 (even V4). Conclusion: It is necessary to do a correct analysis of the electrocardiogram for understanding the mentioned changes and to not assume that the electrocardiographic manifestations are a consequence of multivessel disease.

REFERENCES

1. Carnicer J. Síndromes coronarios agudos con elevación simultánea del segmento ST en derivaciones inferiores y precordiales. Med Intensiva. 2006; 30 (4): 143-148.

2. Geft I, Shah P, Rodríguez L, Hulse S, Maddahi J, Berman DS et al. ST elevations in leads V1 to V5 may be caused by right coronary artery occlusion and acute right ventricular infarction. Am J Cardiol. 1984; 53 (8): 991-996.

3. Serge S, Crawford M. Advanced 12- lead electrocardiography. Cardiol Clin. 2006; 24: 343-365.

4. Domínguez PL, Arias MA, Rodríguez PL. En cardiopatía isquémica: ¿es la elevación del segmento ST en cara anterior sinónimo de infarto agudo de miocardio anterior de ventrículo izquierdo? Rev Clin Esp. 2010; 210: 92-93.

5. Muhammad KI, Kapadia SR. Anterior ST-segment elevation with right coronary artery occlusion: a unique case of isolated right ventricular infarction. Angiology. 2008; 59 (5): 622-624.

6. Porter A, Herz I, Strasberg B. Isolated right ventricular infarction presenting as anterior wall myocardial infarction on electrocardiography. Clin Cardiol. 1997; 20: 971-973.

7. Pozas GG, Valdés GR, Ibarra CS. El método de Grant. Revista AVANCES. 2012; 27 (9): 18-22.

8. Sidhu M, Aggarwal K, Fay W. Acute isolated right ventricular myocardial infarction masquerading as acute anterior myocardial infarction. BMJ Case Rep. 2014; 014; 2014: bcr2012008087.

9. Robalino B, Whitlow P, Underwood D, Salcedo E. Electrocardiographic manifestations of right ventricular infarction. Am Heart J. 1989; 118: 138-144.

10. Hurst J. Comments about the electrocardiographic signs of right ventricular infarction. Clin Cardiol. 1998; 21: 289-291.

11. Carroll R, Sharma N, Butt A, Hussain K. Unusual electrocardiographic presentation of an isolated right ventricular myocardial infarction secondary to thrombotic occlusion of a non-dominant right coronary artery a case report and brief review of literature. Angiology. 2003; 54 (1): 119-124.

12. Sadanandan S, Hochman JS, Kolodziej A, Criger DA, Ross A, Selvester R et al. Clinical and angiographic characteristics of patients with combined anterior and inferior ST-segment elevation on the initial electrocardiogram during acute myocardial infarction. Am Heart J. 2003; 146 (4): 653-661.