Importance of a non‐dominant right coronary artery occlusion presenting as sudden cardiac death with prolonged right ventricular dysfunction and malignant arrhythmias

Abstract

We report a case of a patient who presented with sudden cardiac death secondary to a subtotal occlusion of a small non-dominant right coronary system. Catheterization several weeks following the initial episode revealed persistent severe right ventricular dysfunction with moderate hemodynamic compensation. Continued unstable arrhythmogenic potential at this point led to placement of an AICD device. The case highlights the potential hazard and often complacency involved in dealing with benign appearing lesions as this one.

Ventricular Fibrillation Resulting from Acute Right Ventricular Infarction from Isolated Occlusion of a Right Ventricular Branch Artery

“…,,, ,---,_--.-,. :I In humans, isolated right ventricular infarction with persistent malignant arrhythmia documented by electrophysiology study has been reported in the setting of occlusion of a nondominant right coronary artery (3,12). To our knowledge, this is the only documented case of spontaneous ventricular arrhythmia occurring early after onset and documentation of acute right ventricular infarction resulting from a denovo isolated right ventricular branch occlusion.…”

Acute Thrombotic Occlusion of Non-Dominant Right Coronary Artery Presenting as Acute Coronary Syndrome and Hemodynamic Instability

“…Vural et al reported a case of isolated RV infarction and severe tricuspid regurgitation due to occlusion of nondominant RCA [3] . Karim et al reported a case of a patient who presented with sudden cardiac death secondary to a subtotal occlusion of a small non-dominant right coronary system [4] .…”

Nondominant right coronary artery occlusion and ventricular tachyarrythmias

“…Two similar cases of nondominant right coronary artery occlusion presenting with cardiac death secondary to lethal ventricular arrythmias that were managed conservatively have been reported in the literature [6, 15]. One of them experienced sustained persistent severe right ventricular dysfunction and continued unstable arrhythmias led to placement of an AICD.…”