Cardiogenic shock due to isolated right ventricular infarction in an elderly woman.

A 78-year-old hypertensive woman with no prior history of ischemic heart disease arrived at the hospital complaining of weakness and profound fatigue. Four days earlier, she had experienced substernal chest pain associated with nausea and vomiting. A standard 12-lead electrocardiogram showed marked ST-segment elevation and negative T waves in leads V1 and V2. The patient was treated with anti-thrombotic therapy, dobutamine and dopamine infusions. Angiography showed proximal occlusion of a small, non-dominant right coronary artery and no clinically significant disease in the left coronary artery. Isolated right ventricular infarction accounted for the cardiogenic shock in this elderly patient. She received conservative medical treatment and was discharged in good condition.