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Cardiac Arrest, Ventricular Fibrillation, Inferior and Right ventricular MI (RVMI) or "Pseudoanteroseptal MI"

Posted Jul 14 2010 3:11pm
A 56 yo f with h/o HTN and hypercholesterolemia called EMS from home after onset of L chest pain radiating to the left arm. Before EMS arrived, she had "seizure activity" and became unresponsive. She was defibrillated successfully from ventricular fibrillation and developed a perfusing rhythm. She was intubated. She arrived comatose and in cardiogenic shock and the following ECG was recorded.

There is a bradycardic rhythm of uncertain etiology, possibly a sinus pause with escape, and occasional PVCs.

There is ST elevation in II, III, and aVF, but also ST elevation in V1, but also in V2 and V3. This is diagnostic of Right ventricular MI. RVMI that has ST elevation in V1 all the way to V3 is referred to as "pseudoanteroseptal MI," and is distinguished from LAD anterior MI by the inferior ST elevation (although a "wraparound" LAD can do this) and by the fact that there is more ST elevation in V1 than in V4. That this is an RVMI is confirmed with the following right sided ECG


Now it can be seen that most of the precordial ST elevation is in V4R, much more than is present on the left side of the heart (V1R, which is equivalent to V2 on the left sided ECG.

She was bradycardic and hypotensive. Normal saline bolus was given, with improvement in BP.
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Pressors were required, and the patient was transported to the cath lab with a door to balloon time of 60 minutes, where a proximal dominant RCA occlusion was opened and stented.
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She awoke and was discharged to home with no disability
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