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Vol. 72. Issue 6.
Pages 499 (June 2019)
ECG Contest
DOI: 10.1016/j.rec.2018.05.037
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Response to ECG, May 2019
Respuesta al ECG de mayo de 2019
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Ana Rivero Monteagudoa,
Corresponding author
ana.rivero@fjd.es

Corresponding author:
, Ester Macia Palafoxa, Marta Tomás Mallebrerab
a Departamento de Cardiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
b Departamento de Radiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Rev Esp Cardiol. 2019;72:41910.1016/j.rec.2018.05.038
Ana Rivero Monteagudo, Ester Macia Palafox, Marta Tomás Mallebrera
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In ST-elevation myocardial infarction, the observed ST elevation can due to obstruction of the left anterior descending artery, but such findings would usually be accompanied by ST elevation in the aVR lead and ST depression in the inferior leads (and so response 1 is incorrect). Isolated right ventricular (RV) infarction usually shows more marked ST elevation in leads V1-V2 and a tendency for ST elevation in the inferior leads1 (response 2 incorrect). Although the S1Q3T3 pattern is present, T wave inversions are the precordial electrocardiographic abnormalities usually observed in pulmonary thromboembolism with RV involvement2 while ST elevation is not usually present in these leads. If observed, it would be similar to RV infarction (response 3 incorrect). The correct response is 4, given that ST elevation is more evident in leads V3-V4, which could only be explained by a mass that infiltrates the midapical wall of the RV (Figure).

References
[1]
A.V. Finn, E.M. Antman.
Isolated Right Ventricular Infarction.
N Engl J Med., 349 (2003),
[2]
K. Wang, R.W. Asinger, H.J. Marriot.
ST-segment elevation in conditions other than acute myocardial infarction.
N Engl J Med., 349 (2003), pp. 2128-2135
Copyright © 2018. Sociedad Española de Cardiología
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