Acute chest pain with ST-segment elevation in lead V1-V3: when you hear hoofbeats, also look for zebras

ST-segment elevation (STE) in the anterior precordial leads is the hallmark of anterior myocardial infarction. In rare cases, this ECG pattern may be due to isolated infarction of the right ventricle since leads V1-V3 directly overlie the right ventricular free wall. Herein, we aimed to provide clues to recognize and understand this diagnostic pitfall through a series of 4 patients presenting with STE in the anterior leads.

Automated summary

ST-segment elevation in the anterior precordial leads is a hallmark of anterior myocardial infarction, but in rare cases it can be caused by isolated infarction of the right ventricle. This study aimed to provide clues for recognizing and understanding this diagnostic pitfall through the analysis of 4 patients with STE in the anterior leads.