title: ST-depression in right precordial leads with inferior STEMI and occluded right coronary artery: intertwined anatomy and ischemic areas.
abstract: Right coronary artery (RCA) occlusion in inferior acute myocardial infarction is usually heralded by ST-elevation both in inferior and in right precordial leads. We report the case of a 68-year-old male, who presented marked ST-elevation in inferior leads, mirrored by ST-depression in anterior-septal and lateral leads. Right precordial lead electrocardiogram unexpectedly showed ST-depression V1R-V5R leads. Coronary angiography showed mid-left anterior descending (LAD) coronary near-complete occlusion with distal wrapping LAD. Left circumflex artery was not occluded, while RCA was occluded mid tract. The patient was treated with coronary angioplasty on RCA and LAD. Absence of ST-elevation in right precordial leads may be presumably explained by the presence of a large ischemic area distal to mid-LAD near-occlusive stenosis and of a long-wrapping LAD. Complex coronary anatomy and intertwined ischemic areas may underlie apparently discording electrocardiograms.
authors: a Cardiology Department , Ospedale S. Paolo , Bari , Italy.
authors: Luisa
authors: L
authors: De Gennaro
authors: b Cardiology Department , University of Foggia , Foggia , Italy.
authors: Natale Daniele
authors: http://orcid.org/0000-0001-9610-7408
authors: ND
authors: Brunetti
authors: a Cardiology Department , Ospedale S. Paolo , Bari , Italy.
authors: Massimo
authors: M
authors: Ruggiero
authors: a Cardiology Department , Ospedale S. Paolo , Bari , Italy.
authors: David
authors: D
authors: Rutigliano
authors: a Cardiology Department , Ospedale S. Paolo , Bari , Italy.
authors: Nicola
authors: N
authors: Locuratolo
authors: b Cardiology Department , University of Foggia , Foggia , Italy.
authors: Matteo
authors: M
authors: Di Biase
authors: a Cardiology Department , Ospedale S. Paolo , Bari , Italy.
authors: Pasquale
authors: P
authors: Caldarola
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy
keywords: Inferior ST-elevation acute myocardial infarction; Right precordial leads ST-depression