Sukhvinder Singh1* and Kamal Kumar Sethi2
1Department of Non-invasive Cardiology, Delhi Heart and Lung Institute, Panchkuian Road, New Delhi, India
2Department of Cardiology, Delhi Heart and Lung Institute, Panchkuian Road, New Delhi, India
Received: 07 June, 2016; Accepted: 29 June, 2016; Published: 30 June, 2016
Sukhvinder Singh, Department of Non-invasive Cardiology, Delhi Heart and Lung Institute, Panchkuian Road, New Delhi, 110055, India, Tel- +91-9717205832; E-mail:
Singh S, Sethi KK (2016) Isolated Right Ventricular Myocardial Infarction: An Orphan in Acute Coronary Syndrome Imaging. Global J Med Clin Case Reports 3(1): 018-021. DOI: 10.17352/2455-5282.000027
© 2016 Singh S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Right ventricle; Myocardial infarction; Isolated; Echocardiography; Acute coronary syndrome
ECG: Electrocardiogram; LV: Left Ventricle; MI: Myocardial Infarction; RCA: Right Coronary Artery; RV: Right Ventricle; RVMI: Right Ventricular Myocardial Infarction
Introduction: Isolated right ventricular myocardial infarction is an uncommon entity in the spectrum of acute coronary syndrome. It is often overlooked during the assessment of patients suspected to have acute coronary syndrome.
Case Presentation: A 58 years old male presented with atypical chest discomfort. The initial ECGs were not supporting. The Echocardiogram revealed an isolated right ventricular myocardial wall motion abonrmality that was initially missed. Coronary angiogram revealed a co-dominant circulation with 100% occlusion of proximal right coronary artery. The distal right coronary artery was receiving collateral from left circulation. Successful angioplasty of right coronary artery was done with almost complete recovery of right ventricular function.
Conclusion: The case emphasizes the importance of looking for isolated right ventricular infarction during echocardiography in all cases of suspected acute coronary syndrome.
Isolated right ventricular infarction is an uncommon clinical entity. It is often overlooked during the assessment of patients suspected to have acute coronary syndrome. Moreover, assessment of right ventricular wall motion and function has remained a neglected area in imaging of patients with acute coronary syndrome.
A 58 years old male, non-smoker, non-diabetic, on antihypertensive medication presented with history of episode of pain between the shoulder blades about 60 hours prior to presentation. The pain lasted for one hour when patient was given first aid and admitted to a health facility. The first ECG showed ST elevation in leads III, aVF and V1 with ST depression in leads I and aVL (Figure 1). Patient was conservatively managed for acute coronary syndrome and an echocardiogram was done which was reported to be normal.