Right ventricular infarction with electrocardiographic anterior left ventricular infarction and thrombosis of the left anterior descending coronary artery

Abstract

At necropsy, right ventricular (RV) myocardial infarction secondary to coronary artery disease is observed only in patients with left ventricular (LV) infarction involving the LV posterior (inferior) wall. 1,2 The implication of this observation, of course, is that patients with electrocardiographic evidence of anterior wall LV infarction are spared from RV infarction. Although few reports describing patients with anatomically confirmed RV infarction have illustrated an electrocardiogram, 1–4 it is likely that more than 95% of patients with RV infarction have electrocardiographic evidence of posterior (inferior) LV infarction only. An occasional patient with electrocardiographic evidence of anterior wall myocardial infarction, however, has RV infarction. How can this be? The answer, demonstrated in the patient described herein, is: If the electrocardiogram indicates anterior wall LV infarction, but necropsy also shows RV infarction, the LV infarction in the basal third or so of the LV free wall is limited to the anterior LV free wall with or without involvement of the anterior portion of ventricular septum or lateral LV free wall or both; in the mid or apical third, or both, of the LV wall, however, the LV infarct is circumferential, or nearly so, such that the posterior (inferior) LV wall and posterior portion of ventricular septum indeed is infarcted. The RV infarct then represents an extension from the posterior portion of the ventricular septum.