case_images: PMC3375156_01
case_images: 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.
case_images: CRIM2012-196020.001.jpg
case_images: PMC3375156_01_CRIM2012-196020.001.jpg
case_images: fig1
case_images: 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).
case_images: (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.
case_images: CRIM2012-196020.002.jpg
case_images: PMC3375156_01_CRIM2012-196020.002.jpg
case_images: fig2
case_images: 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)).
case_images: 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.
case_images: CRIM2012-196020.003.jpg
case_images: PMC3375156_01_CRIM2012-196020.003.jpg
case_images: fig3
case_images: The extent of the right coronary dissection was further characterized with intravascular ultrasound (Figure 3).