[Inferior infarct with associated anterior ST elevation: an unusual presentation of right ventricular involvement. Description of three cases and a brief review of the problem].

ST segment elevation in the left precordial leads in the setting of an acute inferior myocardial infarction may represent an unusual electrocardiographic pattern of right ventricular infarction. We present our experience about three patients with first inferior acute myocardial infarction in whom concomitant anterior ST segment elevation was observed. All patients were submitted to urgent coronary angiography because of repeated episodes of myocardial ischemia (case 1) or hemodynamic derangement (case 2, 3) with hypokinetic arrhythmias (case 3). In all patients 2D echocardiographic examination performed before angiography showed a dilated, hypo-akinetic right ventricle and wall motion abnormalities only in inferior, posterior and/or lateral segments of the left ventricle. Proximal right coronary occlusion was found in all patients, and coronary angioplasty was successfully attempted in all but one case. In patients with first inferior myocardial infarction, left precordial ST segment elevation mimicking an anterior infarction may be the less frequent ECG pattern of right ventricle ischemic involvement. Routine right chest leads and early echocardiographic examination allow to identify the patients with right ventricle infarction and concomitant anterior ST segment elevation. In these patients, early and correct diagnosis is important in order to choice the appropriate therapeutic pathway.