PMC3375156_01
Right-sided surface electrocardiogram demonstrating 3rd-degree A-V block and a slow junctional escape rhythm, inferior ST segment elevations with reciprocal lateral ST segment depressions, inferior Q waves, prominent R wave in V1, and right-sided ST elevations in leads V4r-V6r suggesting acute right ventricular myocardial infarction.
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fig1
An EKG revealed sinus tachycardia with 3rd-degree A-V block and a slow junctional escape rhythm, inferior ST segment elevation, and lateral ST segment depression. A right-sided EKG was then obtained with similar findings along with ST segment elevation in V4r-V6r suggesting right ventricular involvement (Figure 1).
(a) Selective angiography of the right coronary artery (RCA) demonstrating a long dissection extending from the mid-to-distal portions (arrowheads), and thrombotic subtotal occlusion of the posterior descending and posterolateral left ventricular arteries (large arrows). (b) Digitally subtracted aortography showing no evidence of ascending aortic dissection.
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fig2
Coronary angiography disclosed a spiral dissection of the mid-right coronary artery (RCA) with thrombus in the posterior descending and posterolateral ventricular arteries (Figure 2(a)) without evidence of ascending aortic dissection on aortography (Figure 2(b)).
IVUS of the RCA showing evidence of coronary artery dissection (intimal flap marked with white arrow) which delineates the true and false lumens. C: IVUS catheter; FL: false lumen; IVUS: intravascular ultrasound; RCA: right coronary artery; TL: true lumen.
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fig3
The extent of the right coronary dissection was further characterized with intravascular ultrasound (Figure 3).