A 77-year-old man suffered out-of-hospital cardiac arrest (CA) secondary to ventricular fibrillation (Figure 1A). The electrocardiogram (ECG) following resuscitation showed ST-segment elevation in V1-V3 (Figure 1B), and he was transferred to our center for urgent coronary angiography. Acute thrombotic occlusion of a non-dominant and poorly developed right coronary artery was observed (Figure 1C and D), which was treated by angioplasty and stenting; this vessel had only two small acute marginal branches to the right ventricle (Figure 1E).
(A) Ventricular fibrillation responsible for out-of-hospital cardiac arrest; (B) electrocardiogram following advanced cardiopulmonary resuscitation maneuvers; (C) angiograms showing acute thrombotic occlusion of the right coronary artery; (D) dominant left circumflex artery; and (E) final result of primary angioplasty of the non-dominant right coronary artery with recovery of flow in the two acute marginal branches to the right ventricle (arrows); (F) electrocardiogram with ST-segment elevation in leads V2R-V4R, confirming right ventricular ischemic injury.
Isolated right ventricular infarction is uncommon, and its first manifestation as CA due to ventricular fibrillation is even rarer in patients with a non-dominant right coronary artery. The electrocardiographic finding of ST-segment elevation in V1-V3 can be confused with anterior myocardial infarction; leads V2R-V4R can help in diagnosis (Figure 1F).
Conflicts of interestThe authors have no conflicts of interest to declare.
Please cite this article as: Ruiz-García J, Pardillos-Ferrer L, Moreno R. Paragem cardíaca extrahospitalar após enfarte isolado do ventrículo direito. Rev Port Cardiol. 2013;32:637–638.
