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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:871 - Vol. 70 Num.10 DOI: 10.1016/j.rec.2017.02.015

Response to ECG, September 2017

Pablo Robles Velasco a,, Isabel Monedero Sánchez a, Roberto del Castillo Medina a

a Unidad de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain

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Free articleECG, September 2017
Pablo Robles Velasco, Isabel Monedero Sánchez, Roberto del Castillo Medina
Rev Esp Cardiol. 2017;70:773
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Coronary angiography showed occlusion of the right coronary artery (RCA) that implicated the origin of a right ventricular branch (Figure, arrow). The artery was opened and the electrocardiogram (ECG) showed correction of the ST abnormalities in the precordial leads (Figure). Occlusion of the left coronary artery leads to an extensive subendocardial lesion with ST elevation in aVR > V1. Simultaneous occlusion of the proximal left anterior descending artery would lead to generalized ST elevation in left precordial leads (answers 1 and 3, incorrect). The ECG is characteristic of acute inferior myocardial infarction with RCA and right ventricular involvement.1 Simultaneous ST elevation in leads V1-V3 suggests a differential diagnosis with occlusion of the distal left anterior descending artery where it passes over the cardiac apex. ST elevation in V1 > V2 > V3 along with ECG showing RCA involvement differentiates the lesion from simultaneous occlusion of a right ventricular branch2 (answer 2 incorrect; the correct answer is answer 4).



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1. Robles P, Jimenez JJ. Working in reverse. Am J Med. 2006;119:1043-4.
2. Alzand BSN, Gorgels APM. Combined anterior and inferior ST-segment elevation Electrocardiographic differentiation between right coronary artery occlusion with predominant right ventricular infarction and distal left anterior descending branch occlusion. J Electrocardiol. 2011;44:383-8.

1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved