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.
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References
Harnett DT, LaHaye SA, Wilkinson JS (2016) Isolated right ventricular myocardial infarction: a sheep in wolf’s clothing. JAMA Intern Med 176(8):1207–1210
Masci PG, Francone M, Desmet W, Ganame J, Todiere G, Donato R et al (2010) Right ventricular ischemic injury in patients with acute ST-segment elevation myocardial infarction: characterization with cardiovascular magnetic resonance. Circulation 122(14):1405–1412
van Oosterom A, Oostendorp TF (2004) ECGSIM: an interactive tool for studying the genesis of QRST waveforms. Heart 90(2):165–168
van Oosterom A, Oostendorp TF, van Dam PM (2011) Potential applications of the new ECGSIM. J Electrocardiol 44(5):577–583
Wellens HJJ, Conover MB (1992) The ECG in emergency decision making, vol 16. W.B. Saunders, Philadelphia, p 229
Sasaki K, Yotsukura M, Sakata K, Yoshino H, Ishikawa K (2001) Relation of ST-segment changes in inferior leads during anterior wall acute myocardial infarction to length and occlusion site of the left anterior descending coronary artery. Am J Cardiol 87(12):1340–1345
Eskola MJ, Kosonen P, Sclarovsky S, Vikman S, Nikus KC (2007) The ECG pattern of isolated right ventricular infarction during percutaneous coronary intervention. Ann Noninvasive Electrocardiol 12(1):83–87
Zehender M, Kasper W, Kauder E, Schonthaler M, Geibel A, Olschewski M et al (1993) Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 328(14):981–988
Barsheshet A, Hod H, Oieru D, Goldenberg I, Sandach A, Beigel R et al (2011) Right precordial lead (V4R) ST-segment elevation is associated with worse prognosis in patients with acute anterior myocardial infarction. J Am Coll Cardiol 58(5):548–549
Kanovsky J, Kala P, Novotny T, Benesova K, Holicka M, Jarkovsky J et al (2016) Association of the right ventricle impairment with electrocardiographic localization and related artery in patients with ST-elevation myocardial infarction. J Electrocardiol 49(6):907–910
Cetin M, Ucar O, Canbay A, Cicekcioglu H, Diker E (2011) Isolated right ventricular myocardial infarction: mimicking anterior myocardial infarction in a patient with coronary artery bypass grafts. Tex Heart Inst J 38(5):598–599
Zhong WW, Blue M, Michaels AD (2019) Acute isolated right ventricular infarction: unusual presentation of anterior ST-segment-elevation myocardial infarction. Tex Heart Inst J 46(2):151–154
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Juerg Schwitter received grants or speaker fees from Bayer Healthcare, Germany. The authors report no other relationship or support that might constitute a conflict of interest.
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The present report was approved by the institutional ethics committee and patients provided written informed consent.
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Pascale, P., Pavon, A.G., Bogaert, J. et al. Acute chest pain with ST-segment elevation in lead V1–V3: when you hear hoofbeats, also look for zebras. Clin Res Cardiol 110, 1516–1522 (2021). https://doi.org/10.1007/s00392-021-01803-4
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DOI: https://doi.org/10.1007/s00392-021-01803-4