A common electrocardiographic finding in an uncommon presentation.

Anterior ST-segment elevation is the hallmark electrocardiographic finding of acute anterior left ventricular infarction that is caused by occlusion in one of the branches of the left coronary artery. We report a case of marked ST-segment elevation in the precordial leads, with concomitant inferior ST-segment elevation that was caused by acute occlusion of the marginal branches of the right coronary artery (RCA) causing an isolated right ventricular myocardial infarction (RVMI) during coronary angioplasty. Isolated occlusion of the marginal branches of the RCA appears to be extremely rare. In the case presented, this was caused by an iatrogenic spiral dissection with subsequent stenting of the RCA. This case illustrates that diffuse ST-segment elevation in the precordial leads may occur due to the occlusion of the RCA or its branches. It is important to recognize this scenario, since the treatment of left ventricular myocardial infarction differs from that of RVMI, where maintaining adequate preload and avoiding vasodilators to preserve right ventricular stroke volume is crucial.