The first appearance deceives many: Isolated RV infarct masq
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Although ST-segment elevation in the precordial leads on an EKG is highly suggestive of occlusion of the left anterior descending artery, the pattern can also result from isolated right ventricular (RV) infarction.

A 55-year-old man with a history of resolved tachycardia-induced cardiomyopathy after AV node ablation and cardiac resynchronization therapy defibrillator (CRT-D) implantation presented with chest pain. The initial EKG demonstrated biventricular pacing with ST elevation in leads V1 to V4. Coronary angiography revealed a left dominant system without occlusive disease.

The nondominant RCA had a 90% stenosis in its proximal segment with thrombolysis in myocardial infarction (TIMI) I flow. The RCA was revascularized with a 2.5 × 16 mm Promus Premier drug-eluting stent. Following restoration of TIMI III flow, the ST elevation in the precordial leads resolved.

Accounting for 3% of all infarctions, RV myocardial infarction (MI) results from occlusion of the RCA proximal to the RV marginal branches. Two previous case reports have reported isolated precordial ST elevation secondary to nondominant RCA occlusion. Although precordial ST elevation is highly indicative of left anterior descending artery occlusion, occlusion of the RV marginal branch of a dominant or nondominant RCA should be entertained in the differential diagnosis.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.3061?af=R
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