Acute chest pain with ST-segment elevation in lead V1-V3: when you hear hoofbeats, also look for zebras

Patrizio Pascale; Anna Giulia Pavon; Jan Bogaert; Johan Bennett; Pierre Monney; Olivier Muller; Juerg Schwitter; Pier Giorgio Masci

doi:10.1007/s00392-021-01803-4

Acute chest pain with ST-segment elevation in lead V1-V3: when you hear hoofbeats, also look for zebras

Clin Res Cardiol. 2021 Sep;110(9):1516-1522. doi: 10.1007/s00392-021-01803-4. Epub 2021 Feb 6.

Authors

Patrizio Pascale^#¹, Anna Giulia Pavon^#², Jan Bogaert³, Johan Bennett³, Pierre Monney^{4

2}, Olivier Muller⁴, Juerg Schwitter^{4

2}, Pier Giorgio Masci⁵

Affiliations

¹ Cardiology Division, Heart and Vessels Department, Lausanne University Hospital, BH 10-982, Rue de Bugnon 46, 1011, Lausanne, Switzerland. Patrizio.Pascale@chuv.ch.
² Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Lausanne, Switzerland.
³ Gasthuisberg University Hospitals, Leuven, Belgium.
⁴ Cardiology Division, Heart and Vessels Department, Lausanne University Hospital, BH 10-982, Rue de Bugnon 46, 1011, Lausanne, Switzerland.
⁵ School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital Campus, Westminster Bridge Road, London, UK.

^# Contributed equally.

PMID: 33547960
DOI: 10.1007/s00392-021-01803-4

Abstract

ST-segment elevation (STE) in the anterior precordial leads is the hallmark of anterior myocardial infarction. In rare cases, this ECG pattern may be due to isolated infarction of the right ventricle since leads V1-V3 directly overlie the right ventricular free wall. Herein, we aimed to provide clues to recognize and understand this diagnostic pitfall through a series of 4 patients presenting with STE in the anterior leads.

Keywords: Anterior ST-elevation; Electrocardiogram; Myocardial infarction; Right ventricle; ST-segment.

Publication types

Case Reports
Letter

MeSH terms

Adult
Chest Pain / etiology*
Diagnosis, Differential
Electrocardiography
Heart Ventricles / physiopathology*
Humans
Male
Middle Aged
Myocardial Infarction / diagnosis*
Myocardial Infarction / physiopathology