Isolated Right Ventricular Infarction: A Case Report and Literature Review

Figures

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  Figure 1.. The ECG obtained at the time of initial admission to the emergency department. The ECG shows junctional rhythm and mild ST-segment elevation in leads V1 to V3. The vector-derived ECG (Nihon Kohden) on arrival showed a 1-mm ST-segment elevation in V3R and V4R of the virtual right precordial leads. The sweep speed was 25 mm/s, 10 mm/mV.

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  Figure 2.. Bedside echocardiography. Echocardiography revealed a normal left ventricular systolic function and right ventricular (RV) dilatation with akinesis of the RV free wall.

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  Figure 3.. Coronary angiography and emergent percutaneous coronary intervention. (A) (B) Coronary angiography demonstrated normal left coronary artery and occlusion of the proximal segment of the nondominant right coronary artery. (C) A 2.25/12-mm everolimus-eluting stent was deployed with achievement of TIMI grade 3 flow.

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  Figure 4.. Clinical course. The acute management required large-volume infusion and administration of multiple catecholamines. For several days, he had repeated paroxysmal atrial fibrillation and junctional rhythm, and his hemodynamics were unstable. In particular, when he was in junctional rhythm (black arrows), he was in shock again and needed a large-volume infusion and increased catecholamine administration. The hemodynamics stabilized after sinus rhythm was maintained. BP: blood pressure, HR: heart rate

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  Figure 5.. Thallium/pyrophosphate (Tl/PYP) dual scintigrams and cardiac magnetic resonance imaging. (A) (a) The Tl/PYP dual scintigrams were performed after three days. The Tl scintigram showed no perfusion defect in LV. (b) The PYP scintigram showed the PYP accumulation only in the RV free wall (yellow arrows). (c) This image is the combination of Tl and PYP scintigrams. (B) Cardiac magnetic resonance after five days revealed delayed enhancement in a part of the RV free wall (yellow arrows).