Acute Isolated Right Ventricular Infarction: Unusual Presentation of Anterior ST-Segment-Elevation Myocardial Infarction.

We describe the cases of 2 patients who presented with acute chest syndrome with isolated ST-segment elevation in leads V1 and V2. Emergency coronary angiograms revealed that acute thrombotic occlusion of the right ventricular marginal branch of the dominant right coronary artery caused the clinical manifestations in the first patient, whereas occlusion of the proximal nondominant right coronary artery was the culprit lesion in the second patient. Both lesions caused right ventricular myocardial infarction. The patients underwent successful primary percutaneous coronary intervention. These cases illustrate the importance of carefully reviewing angiographic findings to accurately diagnose an acute isolated right ventricular myocardial infarction, which may mimic the electrocardiographic features of an anterior-wall myocardial infarction. PMID: 31236085 [PubMed - in process]
Source: Texas Heart Institute Journal - Category: Cardiology Authors: Tags: Tex Heart Inst J Source Type: research

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Post by Smith and MeyersSam Ghali (https://twitter.com/EM_RESUS) just asked me (Smith):" Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR? "Smith and Meyers answer:First, LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded.But if they do present:The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion, though it might be due to subtotal LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Abstract ST-elevation myocardial infarction (STEMI) is a clinical diagnosis based on a compatible history and characteristic electrocardiographic changes. In the current era, STEMI is treated emergently with angiography, leading to percutaneous coronary intervention. However, false-positive electrocardiograms (ECGs) occur, resulting in unnecessary emergent catheterizations. We hypothesized that the Vectraplex cardiac electrical biomarker (CEB) would increase the specificity for the diagnosis of STEMI. We studied 50 patients who were identified by standard of care (clinical history, physical exam, and 12-lead ECG) ...
Source: Baylor University Medical Center Proceedings - Category: Universities & Medical Training Authors: Tags: Proc (Bayl Univ Med Cent) Source Type: research
CONCLUSION:  Cangrelor produces more potent P2Y12 inhibition at the time of first coronary balloon inflation time compared with ticagrelor. Despite this enhanced P2Y12 inhibition, coronary microvascular function and final infarct size did not differ between groups. PMID: 31129911 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: Thromb Haemost Source Type: research
We report a case of a 64-year-old man suspected of myocardial infarction two months previously. Coronary angiography revealed total occlusion of the left anterior descending (LAD), and left ventriculography (LVG) showed remarkably reduced cardiac function and anterior dyskinesis. Electrocardiogram-gated thallium-201 Single Photon Emission Tomography (TL-SPECT) and 18F fluorodeoxyglucose positron emission tomography (FDG) were performed separately, and revealed large anterior myocardial infarction with markedly reduced tracer uptake, suggestive of non-viable myocardium. Percutaneous coronary intervention (PCI) was performed...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
Rationale: de Winter electrocardiograph (ECG) pattern signifies proximal left anterior descending coronary artery (LAD) occlusion and extensive anterior myocardial infarction, and it is found in about 2% of patients with proximal LAD occlusion. However, it is often unrecognized by physicians. In this case report, we present a patient with chest pain but showing an atypical and delayed de Winter ECG pattern. Patient concerns: A previously healthy 61-year-old man attended our emergency department with chest pain radiating to the left arm and back for 4 hours, who was without serious cardiovascular risk factors. ECG at...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Publication date: Available online 8 March 2019Source: Journal of Cardiology CasesAuthor(s): Hiroaki Hiraiwa, Ryota Morimoto, Takahiro Okumura, Yoshihito Arao, Hideo Oishi, Hiroo Kato, Shogo Yamaguchi, Tasuku Kuwayama, Tomoaki Haga, Tsuyoshi Yokoi, Toru Kondo, Naoki Watanabe, Takayuki Mitsuda, Kenji Fukaya, Akinori Sawamura, Akihito Tanaka, Hideki Ishii, Itsuro Morishima, Hideyuki Tsuboi, Toyoaki MuroharaAbstractA 23-year-old Japanese man presented to a nearby hospital with a complaint of chest pain. In terms of the risk factors for cardiovascular events, there were no abnormal findings in past medical examinations and no ...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
Rationale: Primary percutaneous coronary intervention (PPCI) is the most effective therapy for patients with an acute ST-segment elevation myocardial infarction (STEMI). However, up to half of STEMI patients suffer from coronary microvascular dysfunction, presenting as the slow flow or no-reflow phenomenon. Patients concerns: A 78-year-old man was admitted to the chest pain center with sudden chest pain and tightness for about an hour. Diagnoses: Electrocardiography demonstrated ST-segment elevation in leads II, III, aVF, and third-degree atrioventricular block. Coronary angiography showed acute total occlusion in ...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Authors: Arao K, Mase T, Nakai M, Sekiguchi H, Abe Y, Kuroudu N, Oobayashi O Abstract A 71-year-old man presented to our hospital for dyspnea lasting for the past 3 days. Chest X-ray and computed tomography demonstrated right tension pneumothorax, and an electrocardiogram suggested acute inferior myocardial infarction. Despite the relief of tension pneumothorax, the electrocardiographic findings were not completely resolved. Emergency coronary angiography demonstrated an occlusive lesion in the right coronary artery, and percutaneous coronary intervention was performed successfully. Thereafter, the chest tube was r...
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
This study is unable to comment on whether patients with STEMI(-) Occlusion MI have benefit from emergent cath, because that is not the population studied and this subgroup is not commented on.This study is just the most recent in a long long line of similar literature. Context is everything for understanding this study. See below for an excerpt from theOMI Manifesto which summarizes the existing literature and provides details on each study:-------------------------------------------------------------------------------------------------------------- Counter-argument:“Haven’t there been RCTs showing no benefit ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Previously reported electrocardiographic (ECG) criteria to distinguish left circumflex (LCCA) and right coronary artery (RCA) occlusion in patients with acute inferior ST-segment elevation myocardial infarction (STEMI) afford a modest diagnostic accuracy. We aimed to develop a new algorithm overcoming limitations of previous studies. Clinical, ECG, and coronary angiographic data were analyzed in 230 nonselected patients with acute inferior STEMI who underwent primary percutaneous coronary intervention.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
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