Precordial ST segment elevation in acute ischemia caused by right coronary artery occlusion.

The purpose of this study is to determine why precordial ST elevation (V1 lead) occurs during acute occlusion of the right coronary artery (RCA). Nineteen patients with vasospastic angina, in whom ergonovine administration into RCA provoked spasms, were divided into 2 groups by precordial ST change during spasms. Group I (n = 6) had precordial ST elevation; group II (n = 13) had no precordial ST elevation. A subgroup, IIA was comprised 6 patients in group II with spasms in the RCA proximal segment (segment number less than 2 of AHA coronary classification). None had left coronary dominancy. There was no difference in collateral flow during spasms. Location of spasms in group I was in the RCA proximal segment, and was significantly more proximal compared to group II. There was no difference in sigma ST in II, III, aVF between group I and II or IIA. Max ST elevation time by which duration of ischemia was estimated was significantly longer in group I than in group IIA. Three patients in group I displayed precordial ST depression before elevation, in all of whom in sigma ST in II, III, aVF was higher during precordial ST elevation than during depression. During acute occlusion in the RCA proximal segment, precordial ST elevation is caused by ischemia of the right ventricular anterior wall. Furthermore, precordial ST elevation can occur in a patient with RCA dominance, even if ischemic injury in the left ventricular infero-posterior wall increases progressively.

[1]  S. Oesterle,et al.  Precordial ST elevation with acute conus branch occlusion. , 1989, Catheterization and cardiovascular diagnosis.

[2]  H. Kataoka,et al.  Bidirectional precordial ST-T wave changes in pure right ventricular ischemia. , 1988, American heart journal.

[3]  S. Chierchia,et al.  Induction of coronary artery spasm by a direct local action of ergonovine. , 1987, Circulation.

[4]  J. López-Sendón,et al.  Electrocardiographic alterations in leads V1 to V3 in the diagnosis of right and left ventricular infarction. , 1986, American heart journal.

[5]  M. Cohen,et al.  Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. , 1985, Journal of the American College of Cardiology.

[6]  D. Berman,et al.  ST elevations in leads V1 to V5 may be caused by right coronary artery occlusion and acute right ventricular infarction. , 1984, The American journal of cardiology.

[7]  J. Corbett,et al.  Detection of acute right ventricular infarction by right precordial electrocardiography. , 1982, The American journal of cardiology.

[8]  N. Fowler,et al.  Electrocardiographic diagnosis of right ventricular infarction. , 1981, The American journal of medicine.

[9]  W. Edwards,et al.  Aortic origin of conus coronary artery. Evidence of postnatal coronary development. , 1981, British heart journal.

[10]  N. Ratliff,et al.  Combined right and left ventricular infarction: pathogenesis and clinicopathologic correlations. , 1980, The American journal of cardiology.

[11]  W. Roberts,et al.  Right ventricular infarction complicating left ventricular infarction secondary to coronary heart disease. Frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. , 1978, The American journal of cardiology.

[12]  D. Durrer,et al.  Prevalence of right ventricular involvement in inferior wall infarction assessed with myocardial imaging with thallium-201 and technetium-99m pyrophosphate. , 1978, The American journal of cardiology.

[13]  B. Massie,et al.  The Noninvasive Diagnosis of Right Ventricular Infarction , 1978, Circulation.

[14]  M. Weisfeldt,et al.  Right Ventricular Dysfunction Detected by Gated Scintiphotography in Patients with Acute Inferior Myocardial Infarction , 1975, Circulation.

[15]  R. Frye,et al.  A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. , 1975, Circulation.

[16]  N. Ratliff,et al.  Right ventricular infarction: a haemodynamic diagnosis. , 1974, British heart journal.

[17]  B. Befeler,et al.  Dysfunction of the right ventricle in coronary artery disease. , 1974, Chest.

[18]  W. Wade.  THE PATHOGENESIS OF INFARCTION OF THE RIGHT VENTRICLE , 1959, British heart journal.

[19]  P. Zoll,et al.  The conus artery; a third coronary artery. , 1949, American heart journal.