What is the clinical evidence from this study?

Study design: Case Report. Population: 55-year-old man with isolated right ventricular infarction due to proximal occlusion of a non-dominant right coronary artery presenting with acute chest pain and ST-segment elevation in leads V1 and V2 (n=1). Intervention: Thrombus aspiration and reperfusion via percutaneous coronary intervention. Primary outcome: Resolution of ST-segment elevation and reperfusion (TIMI grade III flow) in isolated right ventricular infarction.

What question did this study set out to answer?

To describe the atypical electrocardiographic presentation and clinical management of isolated right ventricular infarction mimicking acute anteroseptal myocardial infarction.

March 8, 2026Frontiers in Cardiovascular MedicineOpen Access

Chest pain with elevated ST segment in lead V1: a case report

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Key result

Thrombus aspiration restores TIMI III flow in a case of isolated RV infarction.

Why the study?

Isolated right ventricular infarction is an underrecognized entity that often mimics anteroseptal myocardial infarction due to ST-segment elevation in precordial leads.

Key Points

To describe the atypical electrocardiographic presentation and clinical management of isolated right ventricular infarction mimicking acute anteroseptal myocardial infarction.
Evaluated a 55-year-old male presenting with acute chest pain and precordial ST-segment elevation using 12-lead electrocardiography.
Performed emergency coronary angiography to identify the culprit vessel, followed by thrombus aspiration and percutaneous coronary intervention.
Electrocardiography demonstrated decremental precordial ST-segment elevation (V1 > V2), concomitant ST-segment elevation in lead III, and reciprocal ST depression in lateral leads.
Coronary angiography revealed proximal occlusion of a non-dominant right coronary artery with no significant obstruction in the left coronary artery.
Post-procedural electrocardiography demonstrated resolution of ST-segment elevation in leads V1 and V2 and normalization of changes in leads I and aVL following successful reperfusion.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

1 55-year-old man presenting with acute chest pain and ST-segment elevation in leads V1 and V2, with a history of hyperlipidemia and long-term smoking.

Intervention

Emergency coronary angiography with thrombus aspiration and reperfusion of the right coronary artery.

Isolated right ventricular infarction can mimic anteroseptal myocardial infarction on ECG, but can be distinguished by decremental ST-segment elevation in precordial leads (V1 > V2) and concomitant ST elevation in lead III.

Limitations

Single patient case report limits generalizability.
Right-sided ECG leads (V3R–V6R) were not recorded for diagnostic confirmation.
Echocardiographic assessment of right ventricular function was not performed immediately, limiting hemodynamic evaluation.
Single-case study limiting generalizability
Right-sided ECG leads (V3R-V6R) were not obtained
Echocardiographic assessment of RV function was not performed immediately

Discussion

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Implication

ECG differentiation of isolated RV from anteroseptal MI guides reperfusion; extends diagnostic criteria but remains hypothesis-generating.

Abstract

Isolated right ventricular infarction (RVI) is an underrecognized clinical entity that often mimics anteroseptal myocardial infarction due to its characteristic ST-segment elevation (STE) in precordial leads. We report the case of a 55-year-old man who presented with acute chest pain and STE in leads V1 and V2. Despite typical anteroseptal infarction patterns, the electrocardiogram (ECG) revealed decremental STE (V1 > V2), concomitant STE in lead III, and reciprocal ST depression in lateral leads. Coronary angiography confirmed proximal occlusion of the non-dominant right coronary artery. This case highlights the diagnostic challenges of isolated RVI and underscores key ECG features that distinguish it from anteroseptal infarction. Early recognition is imperative to avoid detrimental therapies (e.g., vasodilators) and to prioritize reperfusion and preload optimization.

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Published by Frontiers in Cardiovascular Medicine · CC BY

Cite This Study

He et al. (2026) conducted a case report in 55-year-old man with isolated right ventricular infarction due to proximal occlusion of a non-dominant right coronary artery presenting with acute chest pain and ST-segment elevation in leads V1 and V2 (n=1). Thrombus aspiration and reperfusion via percutaneous coronary intervention was evaluated on Resolution of ST-segment elevation and reperfusion (TIMI grade III flow) in isolated right ventricular infarction. Thrombus aspiration and reperfusion successfully restored TIMI grade III flow and normalized ST segments in leads V1 and V2 in a patient with isolated right ventricular infarction due to non-dominant right coronary artery occlusion.

synapsesocial.com/papers/69ada836bc08abd80d5bb50c https://doi.org/10.3389/fcvm.2026.1731030

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Implication

ECG differentiation of isolated RV from anteroseptal MI guides reperfusion; extends diagnostic criteria but remains hypothesis-generating.

Chest pain with elevated ST segment in lead V1: a case report

Key Points

Study Design

Structured PICO

Limitations

Discussion

Implication

Abstract

Figures from the paper

Cite This Study

Chest pain with elevated ST segment in lead V1: a case report

Key Points

Study Design

Structured PICO

Limitations

Discussion

Implication

Abstract

Figures from the paper

Cite This Study

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