ST-depression in right precordial leads with inferior STEMI and occluded right coronary artery: intertwined anatomy and ischemic areas
| Autor: | Luisa De Gennaro, Pasquale Caldarola, Massimo Ruggiero, Nicola Locuratolo, Matteo Di Biase, David Rutigliano, Natale Daniele Brunetti |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Precordial examination Coronary Artery Disease 030204 cardiovascular system & hematology Coronary Angiography 03 medical and health sciences Electrocardiography 0302 clinical medicine Heart Conduction System Internal medicine medicine.artery Angioplasty Occlusion medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Aged ST depression business.industry Coronary anatomy General Medicine medicine.disease Stenosis Right coronary artery cardiovascular system Cardiology ST Elevation Myocardial Infarction medicine.symptom business circulatory and respiratory physiology |
| Zdroj: | Acta clinica Belgica. 72(5) |
| ISSN: | 2295-3337 |
| Popis: | Right coronary artery (RCA) occlusion in inferior acute myocardial infarction is usually heralded by ST-elevation both in inferior and in right precordial leads. We report the case of a 68-year-old male, who presented marked ST-elevation in inferior leads, mirrored by ST-depression in anterior-septal and lateral leads. Right precordial lead electrocardiogram unexpectedly showed ST-depression V1R-V5R leads. Coronary angiography showed mid-left anterior descending (LAD) coronary near-complete occlusion with distal wrapping LAD. Left circumflex artery was not occluded, while RCA was occluded mid tract. The patient was treated with coronary angioplasty on RCA and LAD. Absence of ST-elevation in right precordial leads may be presumably explained by the presence of a large ischemic area distal to mid-LAD near-occlusive stenosis and of a long-wrapping LAD. Complex coronary anatomy and intertwined ischemic areas may underlie apparently discording electrocardiograms. |
| Databáze: | OpenAIRE |
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