Isolated right ventricular dysfunction without myocardial infarction

Right ventricular (RV) infarction or dysfunction is commonly complicated with acute inferior myocardial infarction. In this report, we describe a patient with unstable angina pectoris who showed a temporary isolated RV dysfunction. The patient had total occlusion of proximal right coronary artery, including RV branch, with good collateral circulation from left coronary artery. Recanalization was obtained by percutaneous coronary intervention (PCI). Echocardiography at admission showed RV dilatation and severe hypokinesis of RV free wall but no left ventricular wall motion abnormalities. Hemodynamic examination showed high right atrial pressure with a non-compliant pattern and low cardiac output immediately after PCI. Cardiac enzymes were not elevated even after PCI. RV asynergy and hemodynamics were improved at 2 days after PCI. The 99 m technetium-pyrophosphate and 201 thallium dual single-photon emission computed tomography showed uptake of 99 m technetium-pyrophosphate in only the RV free wall, but in the left ventricle no uptake of 99 m technetium-pyrophosphate and no perfusion defect of 201 thallium.