Images in Clinical Medicine

Isolated Right Ventricular Infarction

Aloke V. Finn, M.D., and Elliott M. Antman, M.D.

N Engl J Med 2003; 349:1636October 23, 2003

• Slide

Article

A 47-year-old man with no history of cardiac disease presented to a hospital, reporting severe substernal chest pressure associated with bilateral arm weakness. A standard 12-lead electrocardiogram (Panel A) showed marked ST-segment elevation in leads V₁, V₂, and V₃ and slight ST-segment elevation in leads II, III, and aVF. The patient was treated with fibrinolytic therapy and transferred to another hospital for catheterization. Angiography showed severe proximal stenosis of a small, nondominant right coronary artery and no clinically significant disease in the left coronary artery. Contrast-enhanced magnetic resonance imaging 48 hours after presentation (Panel B) showed delayed hyperenhancement of the right ventricular (RV) free wall (arrowheads) and sparing of the left ventricle (LV) and the right ventricular apex — observations consistent with the presence of isolated right ventricular infarction.

Isolated right ventricular infarction is uncommon and accounts for less than 3 percent of cases of myocardial infarction with acute ST-segment elevation. The electrocardiographic changes may be misinterpreted as signs of infarction of the anterior wall because of the ST-segment elevation in leads V₁ and V₂. Our patient did not have the typical hemodynamic abnormalities associated with severe right ventricular infarction, probably because of isolated infarction of the right ventricular free wall with sparing of the apex. The patient was discharged in good condition.

Aloke V. Finn, M.D.
Massachusetts General Hospital, Boston, MA 02114

Elliott M. Antman, M.D.
Brigham and Women's Hospital, Boston, MA 02115

Citing Articles (6)

Citing Articles

1. 1

   Becker S.N. Alzand, Anton P.M. Gorgels. (2011) Combined anterior and inferior ST-segment elevation. Journal of Electrocardiology 44:3, 383-388
   CrossRef

2. 2

   Padmini Varadarajan, Ramdas G. Pai, Krishna S. Nayak, Hee-Won Kim, Gerald M. Pohost. 2010. Cardiovascular Magnetic Resonance: Evaluation of Myocardial Function, Perfusion, and Viability. , 196-245.
   CrossRef

3. 3

   Neil E. I. Langlois. (2009) Sudden adult death. Forensic Science, Medicine, and Pathology 5:3, 210-232
   CrossRef

4. 4

   Shumpei Mori, Makoto Takamiya, Kenji Suzuki, Manabu Nakagawa, Hideyuki Akiyama, Taku Honda, Kaname Takizawa, Satomi Fujiwara, Tatsushi Ootomo, Mikio Mitsuoka, Yuuko Ito, Naoto Inoue, Taiichiro Meguro. (2009) Three-dimensional relationship between the conus branch and the precordial leads confirmed by 64–multidetector-row computed tomography. Journal of Electrocardiology 42:2, 118.e1-118.e5
   CrossRef

5. 5

   Theodorus A.M. Kaandorp, Hildo J. Lamb, Don Poldermans, Eric P. Viergever, Eric Boersma, Ernst E. van der Wall, Albert de Roos, Jeroen J. Bax. (2007) Assessment of right ventricular infarction with contrast-enhanced magnetic resonance imaging. Coronary Artery Disease 18:1, 39-43
   CrossRef

6. 6

   Andreas Kumar, Hassan Abdel-Aty, Ilka Kriedemann, Jeanette Schulz-Menger, C. Michael Gross, Rainer Dietz, Matthias G. Friedrich. (2006) Contrast-Enhanced Cardiovascular Magnetic Resonance Imaging of Right Ventricular Infarction. Journal of the American College of Cardiology 48:10, 1969-1976
   CrossRef