Malignant ventricular arrhythmias can result from isolated right ventricular infarction, and reports of this phenomenon in the literature are rare. We present a case of a 46-year-old man with acute onset of chest pain angiographically confirmed to be a result of isolated occlusion of a right ventricular branch artery. He developed ventricular fibrillation within 5 hours of symptom onset. This case highlights the point that despite its benign clinical appearance and preserved left ventricular function, necrosis of right ventricular tissue can have life-threatening consequences.
1. Isner JM, Roberts WC. Right ventricular infarction complicating left ventricular infarction secondary to coronary heart disease: Frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. Am J Cardiol42:885-894, 1978
2.
2. Wartman WB, Hellerstein HK. The incidence of heart disease in 2,000 consecutive autopsies. Ann Intem Med28:41-65, 1948
3.
3. Weiss AT, Flugelman MY, Lewis BS, et al. Isolated right ventricular infarction with ventricular tachycardia. Am Heart J108(2):425-426, 1985
4.
4. Mikdadi G, Wadgaonkar SU, Dhurandhar RW, Quintal RE. Right ventricular infarction complicating right coronary angioplasty. Cathet Cardiovasc Intervent47:327-330, 1999
5.
5. Robalino BD, Whitlow RL, Underwood DA, et al. Electrocardiographic manifestations of right ventricular infarction. Am Heart J118:138-138, 1989
6.
6. Chou TC, Van der Bel-Kahn J, Allen J, et al. Electrocardiographic diagnosis of right ventricular infarction. Am J Med70:1175-1180, 1981
7.
7. Porter A, Herz I, Strasberg B. Isolated right ventricular infarction presenting as anterior wall myocardial infarction on electrocardiography. Clin Cardiol20:971-973, 1997
8.
8. Lopez-Sendon J, Coma-Canella I, Alcasena S, et al. Electrocardiographic findings in acute right ventricular infarction: Sensitivity and specificity of electrocardiographic alterations in right precordial leads V4R, V3R, VI, V2 and V3. J Am Coll Cardiol6:1273-1273, 1985
9.
9. Van der Bolt CLB, Vermeersch PHMJ, Plokker HWM. Isolated acute occlusion of a large right ventricular branch of the right coronary artery following coronary balloon angioplasty: The only true “model” to study Ecg changes in acute, isolated right ventricular infarction. Eur Hreart J17:247-247, 1996
10.
10. Porter A, Herz I, Strasberg B. Isolated right ventricular infarction presenting as anterior wall myocardial infarction on electrocardiography. Clin Cardiol20:971-971, 1997
11.
11. Karagueuzian HS, Sugi K, Ohta M, Fishbein MC, Mandel WJ, Peter T. Inducible sustained ventricular tachycardia and ventricular fibrillation in conscious dogs with isolated right ventricular infarction: Relation to infarct structure. J Am Coll Cardiol7:850-858, 1986
12.
12. Karim MA, Wong C, Armbruster R, Windle J, Deligonul U. Importance of a nondominant right coronary artery occlusion presenting as sudden cardiac death with prolonged right ventricular dysfunction and malignant arrhythmias. Cath Cardiovasc Diag35:257-261, 1995