Isolated right ventricular infarction during angioplasty mimicking anterior myocardial infarction
AbstractImage in cardiovascular revascularization medicine A 55-year-old man was admitted for an elective cardiac catheterization due to a recent non-thrombolyzed inferior myocardial infarction. Angiography of the left system was normal with well-established collaterals to the posterior descending artery ( Figure 1 A). Right angiography revealed total occlusion of the proximal right coronary artery (RCA) distal to the conus branch with a patent right ventricular (RV) branch ( Figure 1 B). During percutaneous transluminal coronary angioplasty (PTCA) and after the first inflation of the balloon in the RCA, a long spiral dissection of the vessel was noted ( Figure 1 C). As a result of this, both the conus branch and the RV branch were occluded, ( Figure 1 D). The dissection was treated successfully with three overlapping stents. Immediately following the procedure, the patient complained of severe chest pain with a precipitous drop in his blood pressure to 90/50 mmHg. A 12-lead electrocardiogram (ECG) showed marked ST-segment elevation in the precordial leads V1 to V4 simulating that of acute anterior wall infarction with no changes in the inferior leads ( Figure 2 B). Right-sided precordial leads revealed ST-segment elevation in leads V1R through V4R ( Figure 2 B).