Acute myocardial infarction with ST segment elevation in inferior and anterior leads: right ventricular infarction

Abstract

We describe the case of a patient who developed an acute myocardial infarction (MI) with ST segment elevations simultaneously in anterior and inferior leads during exercise testing. The patient became hypotensive and unconscious, and an anterior MI was suspected. After systemic thrombolytic therapy, blood pressure improved, and the electrocardiogram (ECG) showed no further ST deviations. Thirty minutes later, chest pain and ST segment elevations recurred. A second thrombolytic bolus was administered, after which the electrocardiographic signs of MI promptly resolved. Coronary angiography revealed two severe complex stenotic lesions in the right coronary artery and one in the left anterior descending coronary artery. Percutaneous coronary intervention and stent implantation were performed in both affected coronary vessels. Interpretation of the ECG indicated clear evidence of an acute inferior wall MI. In this particular case, ST segment elevations in V1-V4 were due to the right ventricular involvement.

Right ventricular infarction: epidemiological, clinical, and angiographic characteristics and the outcomes through the experience of a Moroccan cardiology department

“…Unlike left ventricular infarction, which has been extensively described and studied since antiquity, RVI has been described as a distinct clinical entity since 1974 (Cohn, 1974). In our series, RVMI co-existed with inferior MI in 62.2% of cases and in 37.8% of anterior MI, while isolated RVMI was seen in only one patient, which is similar to others studies 2 , 5 , 6 .…”

“…MI can affect any myocardial territory; however, isolated RVI is very rare 2 , 5 . Nonetheless, the prognosis of inferior MI is better in both the short and the long term than anterior MI 6 . Acute RVMI is frequently associated with inferior wall MI (30–50%) and less frequently with anterior wall MI 7 – 9 , this association worsens the prognosis with a mortality of about 30% compared to that of isolated left ventricular infarctions (6%) 7 .…”

Frequency of Right Ventricular Infarction in Inferior Wall Myocardial Infarction

“…Thus, the author's findings concerning the incidence of RVMI in IWMI are mostly supportive of the available evidence. RVI is less common since the right ventricle is less susceptible to ischemia as oxygen demand is significantly lesser because of its smaller muscle mass, and coronary perfusion in the right ventricle occurs in both systole and diastole [2].…”

“…There was a minimum of 1-mm ST elevation in V4R and V3R. ST-segment elevation in lead V4R is the single most powerful predictor of right ventricular involvement [2]. V4R has 93% sensitivity and 95% specificity for RVI [3].…”