Non-diagnostic 12-Lead Electrocardiogram (ECG) in an Acute Proximal-to-Mid Right Coronary Artery Occlusion: A Case of Isolated Right Ventricular Infarction
Year: 2025
Type: article
Study design: Case Report
Abstract: Proximal-to-mid right coronary artery (RCA) occlusion typically produces inferior ST-segment elevation, yet isolated right ventricular (RV) infarction may appear non-diagnostic on a standard 12-lead electrocardiogram (ECG). A 50-year-old man presented with two hours of chest pain and rising high-sensitivity troponin I levels. The admission 12-lead ECG showed sinus rhythm with left axis deviation and subtle anterior T-wave inversion without inferior ST-segment elevation. Transthoracic echocardiography revealed mild RV dilation and hypokinesis with preserved left ventricular (LV) function. Coronary angiography demonstrated a thrombotic proximal-to-mid RCA occlusion, and primary percutaneous coronary intervention (PCI) restored the Thrombolysis in Myocardial Infarction (TIMI) 3 flow with prompt symptom relief. This case highlights the diagnostic challenge of "ECG-silent" proximal RCA occlusion and emphasizes the role of right-sided leads and early invasive evaluation to avoid delayed reperfusion.
Source: Cureus
DOI: 10.7759/cureus.96144
Authors: Guna Sai Vallapuri, Pankaj V Jariwala, Dilip Gude, Bharat Kumar Reddy K, Sukesh Jangam
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4415927586