Atypical presentation of right coronary artery occlusion

Medicinski pregled
Vladimir IvanovićIlija Srdanović

Abstract

Inferior wall myocardial infarctions are usually benign and uncomplicated and rarely result in ventricular disturbances of the heart rhythm. An unusual presentation of an inferior acute myocardial infarction (AMI) with atypical symptoms, and ventricular tachycardia is described. A 44-year-old patient was admitted to the coronary care unit (CCU) due to atypical chest pain during exercise and ECG abnormalities in leads L2, L3 and aVF. On admission, ECG could mimic myocarditis, pericardial effusion, left anterior bundle branch block or early repolarization. Two-dimensional echocardiography revealed a hypertrophic myocardium without abnormal regional wall motion, good left ventricular function and ejection fraction of 65%. The presumptive prediction of a culprit artery based on the ECG recorded on admission was conclusive for inferior AMI. Fibrinolytic therapy was started 3 hours after the onset of chest pain. Resolution of ST segment elevation and relief of chest pain occurred within one hour of the infusion. On the fifth day after admission, the patient had a nonsustained ventricular tachycardia (VT) which was resolved with amiodarone. Angiography showed acute occlusion of the mid portion, right coronary artery (RCA) and collater...Continue Reading

References

May 1, 1990·International Journal of Cardiology·G VyssoulisP Toutouzas
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Apr 2, 2004·Circulation Journal : Official Journal of the Japanese Circulation Society·Yoshiki NagataTadao Ishikawa
Apr 20, 2004·The Journal of Emergency Medicine·Noelle RotondoRichard A Harrigan
Oct 19, 2004·Journal of the American College of Cardiology·Lukasz SzumowskiMichel Haïssaguerre

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