1/34. Right ventricular ischemia mimicking acute anterior myocardial infarction.Isolated right ventricular ischemia in combination with myocardial infarction (MI) is uncommon, accounting for fewer than 3% of all MI cases. A young man who presented with acute right ventricular ischemia from occlusion of a codominant right coronary artery proximal to an acute marginal branch is presented. His presenting electrocardiogram (ECG) showed ST segment elevation in V1 to V4 mimicking acute anterior MI. ECG criteria for isolated right ventricular ischemia are discussed.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/34. Primary cardiac malignant fibrous histiocytoma in the right ventricular infundibulum treated with a cavo-pulmonary shunt and coronary embolization.A 51-year-old woman presented with progressive right ventricular infundibular wall thickening and outflow obstruction. She had had an aorto-coronary bypass for left main coronary artery disease 1 year after radiation therapy for left mammary cancer. Enhanced computed tomography showed a mass in the right ventricular free wall with no connection to the mediastinum; the tumor extended into the main pulmonary artery, but there was no other evidence of a primary or metastatic tumor. A biopsy specimen was obtained and based on the microscopic and immuno-histochemical findings (vimentin and Kp-1 positive) the diagnosis was primary cardiac malignant fibrous histiocytoma, which is very rare. A cavo-pulmonary artery connection lessened her symptoms, but embolization of the coronary artery to try and to reduce the mass had minimal effect. Four months after the tumor was diagnosed she died of extended pulmonary artery obstruction.- - - - - - - - - - ranking = 7keywords = coronary (Clic here for more details about this article) |
3/34. Transient but marked ST elevation in precordial leads caused by ischemia of the isolated right ventricular branch.The present case is a 64 year-old man in whom transient but marked ST elevation was confirmed in the contralateral precordial leads (V1-3) during percutaneous transluminal coronary angioplasty (PTCA) of the proximal right coronary artery, suggesting that the patient had anteroseptal ischemia. The ST elevation persisted even after the balloon was deflated, and no changes in the left coronary artery were detected. In addition, blood flow in the affected area of the right coronary artery was favorable and there was a transient delay only in the right ventricular branch. Once blood flow in the right ventricular branch improved, ST returned to baseline, and when the right ventricular branch was again occluded by the balloon, ST elevation occurred in a reproducible manner. Hence, the electrocardiographic changes in the precordial leads were caused by occlusion of the right ventricular branch. It is rare to observe ST elevation caused by isolated right ventricular branch ischemia.- - - - - - - - - - ranking = 4keywords = coronary (Clic here for more details about this article) |
4/34. Isolated right ventricular infarction.Rare occurrence of isolated right ventricular infarction is reported in four patients, three of whom were elderly. The causes of infarction were due to pulmonary thromboembolism and dissection of non-dominant right coronary artery. None of the hearts had right ventricular hypertrophy and significant coronary atherosclerosis.- - - - - - - - - - ranking = 2keywords = coronary (Clic here for more details about this article) |
5/34. Severe intracranial bleeding mimicking acute inferior myocardial infarction with right ventricular involvement.Electrocardiographic (ECG) changes and wall motion abnormalities of the left ventricle have been observed in patients with severe intracranial hemorrhage. However, ECG evidence of an acute myocardial infarction in this setting is extremely rare but may have important therapeutic consequences. We report the case of a 45-year-old female who became unconscious with respiratory insufficiency after an endoscopic retrograde cholangiopancreaticoscopy with ECG changes consistent of an inferior myocardial infarction with right ventricular involvement. Immediate coronary angiography revealed normal coronaries; however, left ventricular angiography showed extensive wall motion abnormalities predominantly in the anteroseptal region. Immediate cranial computer tomography demonstrated massive intracranial bleeding. Intracranial hemorrhage can be associated in the initial phase with ECG evidence of an acute myocardial infarction. This has to be taken into consideration in the setting of unexplained loss of consciousness or nonresponsiveness of a patient. A rapid diagnostic evaluation has to be initiated to rule out a myocardial infarction and to diagnose intracranial hemorrhage before the use of thrombolytic or anticoagulant therapy.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
6/34. Primary angioplasty for isolated right ventricular infarction.We describe a case of isolated right ventricular infarction that has rarely been diagnosed antemortem. Electrocardiogram showed ST segment elevation in left precordial chest, right precordial chest, and inferior leads, which mimicked those of anterior and inferior left ventricular infarction. coronary angiography revealed that culprit lesion was totally occluded right coronary artery. Infarcted artery was nondominant right coronary artery with branches supplying only right ventricular wall. Restoration of coronary blood flow was obtained by primary stenting and resulted in prompt ST segment normalization in all leads. Despite extensive right ventricular wall motion abnormality, subsequent right ventricular dysfunction was not observed.- - - - - - - - - - ranking = 3keywords = coronary (Clic here for more details about this article) |
7/34. ST elevation in the anterior precordial leads during right ventricular infarction: lessons learned during primary coronary angioplasty--a case report.ST elevation in the anterior leads may be due to isolated right ventricular infarction associated with occlusion of a nondominant or codominant right coronary artery. The authors report a case of isolated right ventricular infarction from a dominant right coronary artery's proximal occlusion in the presence of collateral circulation provided by the left coronary artery. Extensive damage occurred owing to compromise of the collateral circulation during primary coronary angioplasty. This is an unusual angiographic pattern for isolated right ventricular infarction. The potential consequences of percutaneous interventions to collateral vessels is discussed.- - - - - - - - - - ranking = 8.1576078806311keywords = coronary, circulation (Clic here for more details about this article) |
8/34. Acute right ventricular failure during aortic root replacement: intraoperative diagnosis and treatment.The scope of this article is to report on a patient who underwent a Bentall procedure for type A aortic dissection. Right ventricular (RV) failure developed immediately after completion of the operation. The etiology was determined by using transit time flow measurement (TTFM), an ultrasound-based technique which demonstrated the absence of blood flow to the right coronary artery. This allowed for early and effective treatment, which was followed by a successful outcome.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
9/34. Pure right ventricular infarction.A 76-year-old man with chest pain was admitted to hospital where electrocardiography (ECG) showed ST-segment elevation in leads V1-4, indicative of acute anterior myocardial infarction. ST-segment elevation was also present in the right precordial leads V4R-6R. Emergency coronary angiography revealed that the left coronary artery was dominant and did not have significant stenosis. aortography showed ostial occlusion of the right coronary artery (RCA). Left ventriculography showed normal function and right ventriculography showed a dilated right ventricle and severe hypokinesis of the right ventricular free wall. Conservative treatment was selected because the patient's symptoms soon ameliorated and his hemodynamics was stable. 99mTc-pyrophosphate and 201Tl dual single-photon emission computed tomography showed uptake of 99mTc-pyrophosphate in only the right ventricular free wall, but no uptake of 99mTc-pyrophosphate and no perfusion defect of 201Tl in the left ventricle. The peak creatine kinase (CK) and CK-MB were 1,381 IU/L and 127 IU/L, respectively. His natural course was favorable and the chest pain disappeared under medication. Two months after the onset, the ECG showed poor R progression in leads V1-4 indicating an old anterior infarction. coronary angiography confirmed the ostial stenosis of the hypoplastic RCA. This was a case of pure right ventricular free wall infarction because of the occlusion of the ostium of the hypoplastic RCA, but not of the right ventricular branch. Because the electrocardiographic findings resemble those of an acute anterior infarction, it is important to consider pure right ventricular infarction in the differential diagnosis.- - - - - - - - - - ranking = 3keywords = coronary (Clic here for more details about this article) |
10/34. nitric oxide inhalation is useful in the management of right ventricular failure caused by myocardial infarction.OBJECTIVE: To describe hemodynamic improvement in a patient treated with nitric oxide (NO) inhalation in the management of right ventricular failure caused by myocardial infarction. DESIGN: Case report. SETTING: An intensive care unit of a university hospital. PATIENT: A 66-yr-old man with severe right ventricular failure caused by acute myocardial infarction. INTERVENTIONS: nitric oxide inhalation through a ventilator circuit. MEASUREMENTS AND MAIN RESULTS: The patient complained of chest pain. When myocardial infarction was diagnosed, he underwent percutaneous transluminal coronary angioplasty and percutaneous transluminal coronary recanalization, but they were not effective. We instituted intra-aortic balloon pumping and brought the patient to the intensive care unit (ICU). Even with high-dose inotropic support, his hemodynamics deteriorated gradually. On the patient's seventh day in the ICU, we started NO inhalation at 5-10 ppm in an attempt to relieve his right heart failure. Immediately after NO inhalation was started, his hemodynamics improved significantly, and we could wean the patient from intra-aortic balloon pumping. NO inhalation was continued for 9 days and was successfully discontinued without circulatory deterioration. He was discharged from our hospital uneventfully. CONCLUSION: nitric oxide inhalation improved hemodynamics in our patient with right ventricular failure after myocardial infarction. Our report suggests that a clinical trial of NO treatment for severe right ventricular failure caused by myocardial infarction is warranted.- - - - - - - - - - ranking = 2keywords = coronary (Clic here for more details about this article) |
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