Isolated Right Ventricular Infarction

A 47-year-old man with no history of cardiac disease presented to a hospital, reporting severe substernal chest pressure associated with bilateral arm weakness. A standard 12-lead electrocardiogram (Panel A) showed marked ST-segment elevation in leads V1, V2, and V3 and slight ST-segment elevation in leads II, III, and aVF. The patient was treated with fibrinolytic therapy and transferred to another hospital for catheterization. Angiography showed severe proximal stenosis of a small, nondominant right coronary artery and no clinically significant disease in the left coronary artery. Contrast-enhanced magnetic resonance imaging 48 hours after presentation (Panel B) . . .