Occlusion of the Right Ventricular Wall Branch of a Recessive Right Coronary Artery Resulting in Ventricular Fibrillation and Anterior ST-Segment Elevation—A Case Report

• Main Authors: Harish Sharma, Sudhakar George
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2020-07-01
• Series: Frontiers in Cardiovascular Medicine
• Subjects: RV branch occlusion; anterior ST elevation; ventricular fibrillation; myocardial infarction; right ventricular infarction
• Online Access: https://www.frontiersin.org/article/10.3389/fcvm.2020.00124/full

Background: Right ventricular (RV) infarction is as an extremely rare cause of isolated anterior ST-segment elevation. Occlusion of the RV branch in a recessive right coronary artery (RCA) causing isolated RV infarction and only anterior ST-elevation is extremely rare. To date, the handful of such cases reports do not describe any arrhythmia associated with this presentation. Although ventricular fibrillation (VF) has been well-documented with interruption of flow in the conus branch of the RCA, here we describe VF occurring in a patient with occlusion of the RV branch of a recessive RCA presenting with isolated anterior ST-segment elevation.Case: A 51-year-old man presented with acute chest pain and isolated anterior ST-segment elevation on electrocardiogram (ECG). The patient developed ventricular fibrillation prior to coronary angiography requiring cardiopulmonary resuscitation. Coronary angiography revealed an unobstructed left coronary system and a recessive right coronary artery with ostial occlusion of the RV branch which was treated with a drug eluting balloon, resulting in resolution of the chest pain and ECG changes.Conclusion: Isolated RV infarction due to RV branch occlusion can cause ECG changes mimic anterior left ventricular infarction. This presentation may be complicated by VF, even in the setting of a recessive RCA.