Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2021; 9(8): 1877-1884
Published online Mar 16, 2021. doi: 10.12998/wjcc.v9.i8.1877
Chest pain showing precordial ST-segment elevation in a 96-year-old woman with right coronary artery occlusion: A case report
Hao-Yu Wu, Gong Cheng, Yi-Wei Cao
Hao-Yu Wu, Gong Cheng, Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
Yi-Wei Cao, Department of Electrocardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
Author contributions: Wu HY and Cao YW drafted the manuscript; Wu HY and Cheng G participated in the treatment of this patient; Wu HY, Cheng G and Cao YW revised the manuscript; All authors approved the final version of the manuscript.
Supported by Natural Science Basic Research Program of Shaanxi Province, No. 2020JQ-939.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yi-Wei Cao, MD, PhD, Doctor, Department of Electrocardiology, Shaanxi Provincial People’s Hospital, No. 256, West Youyi Road, Xi’an 710068, Shaanxi Province, China. 807422365@qq.com
Received: September 20, 2020
Peer-review started: September 20, 2020
First decision: December 14, 2020
Revised: December 23, 2020
Accepted: January 6, 2021
Article in press: January 6, 2021
Published online: March 16, 2021
Processing time: 166 Days and 2.8 Hours
Abstract
BACKGROUND

Typically, right coronary artery (RCA) occlusion causes ST-segment elevation in inferior leads. However, it is rarely observed that RCA occlusion causes ST-segment elevation only in precordial leads. In general, an electrocardiogram is considered to be the most important method for determining the infarct-related artery, and recognizing this is helpful for timely discrimination of the culprit artery for reperfusion therapy. In this case, an elderly woman presented with chest pain showing dynamic changes in precordial ST-segment elevation with RCA occlusion.

CASE SUMMARY

A 96-year-old woman presented with acute chest pain showing precordial ST-segment elevation with dynamic changes. Myocardial injury markers became positive. Coronary angiography indicated acute total occlusion of the proximal nondominant RCA, mild atherosclerosis of left anterior descending artery and 75% stenosis in the left circumflex coronary artery. Percutaneous coronary intervention was conducted for the RCA. Repeated manual thrombus aspiration was performed, and fresh thrombus was aspirated. A 2 mm × 15 mm balloon was used to dilate the RCA with an acceptable angiographic result. The patient’s chest pain was relieved immediately. A postprocedural electrocardiogram showed alleviation of precordial ST-segment elevation. The diagnosis of acute isolated right ventricular infarction caused by proximal nondominant RCA occlusion was confirmed. Echocardiography indicated normal motion of the left ventricular anterior wall and interventricular septum (ejection fraction of 54%), and the right ventricle was slightly dilated. The patient was asymptomatic during the 9-mo follow-up period.

CONCLUSION

Cardiologists should be conscious that precordial ST-segment elevation may be caused by occlusion of the nondominant RCA.

Keywords: Precordial ST-segment elevation; Electrocardiogram; Isolated right ventricular infarction; Right coronary artery occlusion; Chest pain; Case report

Core Tip: It is rarely observed that right coronary artery occlusion causes ST-segment elevation only in precordial leads without inferior lead elevation. Electrocardiograms are often used by cardiologists to identify the infarct-related artery. This case emphasizes the importance for cardiologists to be conscious that occlusion of the nondominant right coronary artery can cause precordial ST-segment elevation. Recognizing this is helpful for discriminating the culprit artery for timely reperfusion therapy.