Ding Di, Sun Xusen, Sun Xiaochen
Department of Cardiology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.
J Electrocardiol. 2025 Sep-Oct;92:154102. doi: 10.1016/j.jelectrocard.2025.154102. Epub 2025 Aug 19.
Anterior ST-segment elevation is conventionally attributed to acute occlusion of the left anterior descending (LAD) artery. However, isolated right ventricular myocardial infarction (RVMI), though exceedingly rare, may present with a similar electrocardiographic pattern, thereby posing a diagnostic challenge. We describe a 44-year-old male patient who presented with acute retrosternal chest pain and exhibited dome-like ST-segment elevation in leads V1-V4, without reciprocal ST-segment depression in the inferior leads. Despite initial suspicion of anterior ST-elevation myocardial infarction (STEMI) due to presumed LAD involvement, emergent coronary angiography revealed a complete proximal occlusion of the right coronary artery (RCA), which gave rise to a well-developed posterior descending artery (PDA) following recanalization, alongside a small PDA from the left circumflex artery, consistent with a balanced-dominant coronary circulation. A diagnosis of isolated RVMI was subsequently confirmed. This case emphasizes the need to consider RVMI in the differential diagnosis of anterior ST-segment elevation, particularly in patients with balanced-dominant anatomy, where dual-PDA supply may obscure classic inferior infarct patterns and lead to diagnostic confusion.
传统上，前壁ST段抬高归因于左前降支（LAD）动脉急性闭塞。然而，孤立性右心室心肌梗死（RVMI）虽然极为罕见，但可能呈现类似的心电图模式，从而带来诊断挑战。我们描述了一名44岁男性患者，他因急性胸骨后胸痛就诊，V1-V4导联出现圆顶状ST段抬高，下壁导联无ST段对应性压低。尽管最初因推测LAD受累而怀疑为前壁ST段抬高型心肌梗死（STEMI），但紧急冠状动脉造影显示右冠状动脉（RCA）近端完全闭塞，再通后形成一支发育良好的后降支动脉（PDA），同时左回旋支动脉也发出一小支PDA，符合均衡优势型冠状动脉循环。随后确诊为孤立性RVMI。该病例强调，在鉴别诊断前壁ST段抬高时，尤其是在均衡优势型解剖结构的患者中，需要考虑RVMI，因为双PDA供血可能掩盖典型的下壁梗死模式并导致诊断混淆。
