title: A totally occluded right coronary artery presenting with a normal electrocardiogram.
abstract: Total occlusion of the right coronary artery (RCA) typically manifests as ST-segment elevation in the inferior leads and sometimes the lateral precordial leads of the surface electrocardiogram (ECG). We report a case of a patient with a normal electrocardiogram on presentation who, on angiography, revealed a totally occluded proximal RCA. Emergency angioplasty and stenting was successfully able to recanalize the entire RCA and restore TIMI III flow. ECGs performed post-procedure showed minimal change. The existence of a subendocardial microvascular network may have allowed this patient to escape what typically would have been a large ST-elevation inferior myocardial infarction.
authors.affiliation: Comprehensive Cardiac Care, Inc., 1017 Butte Street, Redding, CA 96001, USA. tripleC@C-zone.net
authors.forename: Vimal I
authors.initials: VI
authors.lastname: Nanavati
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Knapp
authors.forename: Susan
authors.initials: S
authors.lastname: Passelaqua
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D002637:Chest Pain / Q000175:diagnosis; D017023:Coronary Angiography / Q000379:methods; D003331:Coronary Vessels / Q000473:pathology; D004562:Electrocardiography; D005188:False Negative Reactions; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011379:Prognosis; D012016:Reference Values; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome