Malignant ventricular arrhythmias resulting from isolated right ventricular myocardial
infarction (RVMI) without left ventricular myocardial ischaemia or infarction occur
rarely. We present a case of a 61 year-old male with acute onset of chest pain and
ventricular fibrillation cardiac arrest requiring prompt defibrillation. Subsequent
15-lead EKG, showed ST-segment elevation in the anterior and right precordial leads
without ST-segment elevation in the inferior leads. Angiography documented occlusion
of a large RV marginal branch. Delayed enhancement cardiac magnetic resonance imaging
(DE-CMR) with gadolinium performed two days post-infarct showed isolated RVMI. Patient
remained symptom free and haemodynamically stable throughout his hospital stay. The
clinical presentation of isolated RV infarct can be misleading and diagnosis difficult.
EKG findings can resemble acute anterior wall myocardial infarction, while its course
can be accompanied by life-threatening ventricular arrhythmias. This case uniquely
combines this rare clinical sequence with DE-CMR images using gadolinium to confirm
isolated RVMI. A brief review of RVMI presentation and associated EKG patterns is
also discussed.
Keywords
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Article info
Publication history
Accepted:
May 20,
2010
Received in revised form:
February 22,
2010
Received:
June 10,
2009
Identification
Copyright
Published by Elsevier Inc.
