Isolated Right Ventricular Myocardial Infarction

Harnett, David T.; LaHaye, Stephen A.; Wilkinson, Jeffrey S.

doi:10.1001/jamainternmed.2016.3085

Cited by 11 publications

(10 citation statements)

References 7 publications

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“…Electrocardiographic criteria have been used to differentiate an acute occlusion of the LAD from an occlusion of the RV marginal branch. 7 Some investigators have suggested that the latter typically lacks reciprocal changes on the ECG, as we observed in our patients. Others have reported that STE primarily in V 1 suggests an isolated RV infarction because lead V 1 directly faces the RV.…”

Section: Discussionsupporting

confidence: 74%

Acute Isolated Right Ventricular Infarction: Unusual Presentation of Anterior ST-Segment-Elevation Myocardial Infarction

Zhong¹,

Blue²,

Michaels³

2019

Texas Heart Institute Journal

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Acute right ventricular infarction presenting with ST-segment elevation in the anterior precordial electrocardiographic leads is an unusual event. Anterior ST-segment elevation typically suggests occlusion of the left anterior descending coronary artery. It should be recognized, however, that occlusion of a right coronary artery branch can cause isolated ST-segment elevation in leads V 1 and V 2 on a standard 12-lead electrocardiogram. We describe the cases of 2 patients who presented with acute chest syndrome with isolated ST-segment elevation in leads V 1 and V 2 . Emergency coronary angiograms revealed that acute thrombotic occlusion of the right ventricular marginal branch of the dominant right coronary artery caused the clinical manifestations in the first patient, whereas occlusion of the proximal nondominant right coronary artery was the culprit lesion in the second patient. Both lesions caused right ventricular myocardial infarction. The patients underwent successful primary percutaneous coronary intervention. These cases illustrate the importance of carefully reviewing angiographic findings to accurately diagnose an acute isolated right ventricular myocardial infarction, which may mimic the electrocardiographic features of an anterior-wall myocardial infarction. (Tex Heart Inst J 2019;46(2):151-4)S T-segment elevation (STE) in precordial electrocardiographic (ECG) leads V 1 and V 2 typically indicates occlusion of the left anterior descending coronary artery (LAD). However, in rare cases, isolated STE in these leads has been associated with acute right ventricular (RV) marginal branch occlusion, 1-7 because leads V 1 and V 2 lie directly over the RV.We describe the cases of 2 patients who presented with acute STE in leads V 1 and V 2 caused by occlusion, involving the RV marginal branch of the dominant right coronary artery (RCA) in the first case and the proximal nondominant RCA in the second case. The patients were treated by means of primary percutaneous coronary intervention (PCI). These cases highlight the importance of considering an RCA occlusion as a potential cause of isolated RV myocardial infarction when ECG features suggest an acute anterior-wall STE myocardial infarction (STEMI). Recognizing this pattern in patients with acute STEMI can help to identify the culprit arteries for timely initiation of reperfusion therapy. Case Reports Patient 1In December 2016, a 52-year-old obese man presented at our hospital with a 90-minute history of acute left-sided neck and upper chest pain. Standard 12-lead ECG showed STE in leads V 1 and V 2 (Fig. 1). Emergency coronary artery angiograms revealed a smooth, nonthrombotic mid-LAD stenosis of intermediate severity (70%), an anomalous origin of the left circumflex coronary artery from the proximal RCA, nonobstructive atherosclerotic plaque in the dominant RCA, and acute thrombotic occlusion of the proximal RV branch (Fig. 2).We used a 2 × 23-mm bare-metal MultiLink Vision ® coronary stent (Abbott Vascular) to treat the proximal RV branch occlusion and achie...

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Section: Discussionsupporting

confidence: 74%

Acute Isolated Right Ventricular Infarction: Unusual Presentation of Anterior ST-Segment-Elevation Myocardial Infarction

Zhong¹,

Blue²,

Michaels³

2019

Texas Heart Institute Journal

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“…1,3 Such entity may occur through any of the four mechanisms proposed below: 1) isolated occlusion of the acute marginal branch of the RCA; 2) non-dominant or co-dominant RCA occlusion; 3) proximal occlusion of a dominant RCA in patients with: 3a) AMI in the old inferior wall of the LV and occlusion of the middle or distal RCA; 3b) or bypass graft for RCA with insufficient retrograde filling to the acute marginal branch; 3c) or with collateralization from the LCA to the right posterior descending branch, but insufficient retrograde filling of the acute marginal branch; 4) occlusion of a non-dominant RCA with anomalous origin. 1 ST-segment elevation in anterior leads (V1 -V3) is described in cases of isolated RV AMI due to its typical topography (anterior heart chamber). 1,2 Association of this specific electrocardiographic pattern with isolated RV myocardial infarction was previously documented in a canine model and by autopsy in humans.…”

Section: Discussionmentioning

confidence: 99%

“…1 ST-segment elevation in anterior leads (V1 -V3) is described in cases of isolated RV AMI due to its typical topography (anterior heart chamber). 1,2 Association of this specific electrocardiographic pattern with isolated RV myocardial infarction was previously documented in a canine model and by autopsy in humans.…”

Section: Discussionmentioning

confidence: 99%

“…Right ventricular (RV) ischemic involvement during acute coronary syndromes (ACS) is typically recognized associated with acute myocardial infarction (AMI) with ST-segment elevation in the inferior left ventricular (LV) wall, usually caused by proximal occlusion of the right coronary artery (RCA). 1 In contrast, isolated RV myocardial infarction is a rare entity that mimics anterior myocardial infarction of the left ventricle (LV), both clinically and in the electrocardiographic (ECG) presentation, due to the anatomical topography of the RV located in a more anterior position. 2 The use of cardiac magnetic resonance (CMR) in myocardial infarction adds to the more usual methods, a high diagnostic potential, especially when other markers or tests have limitations, such as in subacute infarction, previous infarction or isolated right ventricular involvement.…”

Section: Introductionmentioning

confidence: 99%

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Isolated right ventricle acute myocardial infarction - report of two unusual cases

JRA¹,

MJ²,

RB³

et al. 2021

JCCR

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Right ventricular ischemic involvement during acute coronary syndromes is typically recognized associated with acute myocardial infarction with ST-segment elevation in the inferior left ventricular wall. In contrast, isolated right ventricular myocardial infarction is a rare entity that mimics anterior myocardial infarction of the left ventricle, both clinically and in the electrocardiographic presentation. We report two cases of isolated right ventricle acute myocardial infarction simulating anterior wall myocardial infarction.

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“…Right ventricular myocardial infarction (RVMI) complicates one third to one half of patients with inferior myocardial infarc-tion [11,12], less than 10% of patients with anterior myocardial infarction, though isolated RVMI is rare (<3% of all cases of fatal infarction) [13][14][15][16][17]. The short-term prognosis of RVMI is reserved due to hemodynamic and electrophysiological complications [18], and timely identification and treatment of these patients is very important for reducing mortality [19,20].…”

Section: Introductionmentioning

confidence: 99%

Myocardial infarction with cardiogenic shock---the experience of a primary PCI centre from North-East Romania

Anghel¹,

Sascau²,

Stătescu³

2021

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Objectives: To evaluate the severity of acute myocardial infarction (AMI) complicated with cardiogenic shock (CS), by comparison with inferior and right ventricular AMI, which is also considered a severe form of myocardial infarction. Methods: In an observational study, from 774 patients with STEMI hospitalized in our Cardiology Institute, over one year and a half, only 120 patients met the inclusion and exclusion criteria (60 patients with CS and 60 patients with right ventricular AMI). Data collected included age, sex, vital signs, oxygen saturation, respiratory rate, left ventricular ejection fraction, right ventricular dysfunction, complications during hospitalization and coronarography results. Results: Patients with CS had a more severe systolic dysfunction (median ejection fraction 22.72 ± 12.30% vs. 41.93 ± 10.50%, P < 0.0001). Single-vessel disease was the most common in both groups, left anterior descending artery being the culprit artery in most patients with cardiogenic shock, 25% of them having residual lesions with a severity >75%. Using a multivariate analysis, we observed that for patients with CS, delayed coronary angiography evaluation, as well as the presence of severe triple-vessel disease, were associated with a higher risk of death. In-hospital mortality (53.33% vs. 8.33%, P < 0.0001) and ventricular arrhythmia were significantly higher in patients with CS (48.3% vs. 11.3%, P < 0.0001). Conclusions: Our study suggests that patients with AMI and CS can be considered the most severe form of myocardial infarction and should, therefore, benefit of prompt and appropriate treatment, to improve the outcome.

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Isolated Right Ventricular Myocardial Infarction

Cited by 11 publications

References 7 publications

Acute Isolated Right Ventricular Infarction: Unusual Presentation of Anterior ST-Segment-Elevation Myocardial Infarction

Acute Isolated Right Ventricular Infarction: Unusual Presentation of Anterior ST-Segment-Elevation Myocardial Infarction

Isolated right ventricle acute myocardial infarction - report of two unusual cases

Myocardial infarction with cardiogenic shock---the experience of a primary PCI centre from North-East Romania

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