Isolated right ventricular infarction: a diagnostic challenge

Abstract

A 73-year-old woman was admitted to the emergency room due to sudden-onset dyspnoea, altered mental status and haemodynamic instability. ECG showed a junctional rhythm, T-wave inversion in I, aVL and V2-V6 (present in a previous ECG), and no ST/T changes in the right precordial leads. Transthoracic echocardiography, however, revealed a severe depression of global systolic function of right ventricle with akinesia of free wall and a normal left ventricular function. Coronary angiography showed an occlusion of the proximal segment of the right coronary artery, which was treated with balloon angioplasty, and a chronic lesion of the anterior descending artery. The patient had a good recovery and was discharged on the 14th day. Myocardial perfusion scintigraphy (stress and rest) was performed a month later, showing a fixed perfusion defect in the apex and anterior wall (medium-apical), with no signs of ischaemia.

Diagnostic Traps—Noteworthy Electrocardiogram Patterns

“…The classic triad consists of hypotension, clear lung fields, and raised jugular venous pressure. 2 The ECG plays an important role in establishing the diagnosis. There are 2 main ECG patterns of IRVMI.…”

“…Clinical presentation of IRVMI may be very distinct. The classic triad consists of hypotension, clear lung fields, and raised jugular venous pressure . The ECG plays an important role in establishing the diagnosis.…”