Right coronary artery occlusion

Fiol M, Carrillo A, Cygankiewicz I et al. New criteria based on ST changes in 12 leads surface ECG to detect proximal vs distal right coronary artery occlusion in case of an acute inferoposterior myocardial infarction. Ann Nonin-vasive Electrocardiol 2004a 9 383. 

Shen Wei, Xing Hui, Wang Man, Gong Lan. Myocardial infarction due to isolated left circumflex or right coronary artery occlusion. Chin Med J 1991 104 369. 

Two-vessel coronary artery disease (60% right coronary artery [RCA] and 80% left anterior descending artery [LAD] occlusion) after intracoronary CYPHER stent placement to the mid-LAD artery lesion 10 months ago. 

Coronary angiography in two patients who had an asymptomatic occlusion of the right coronary artery with extensive collaterals from the left coronary system. The right coronary artery (black arrows) fills by intramyocardial collaterals (left, white arrows) or large bore epicardial collaterals (right white arrows) underscoring the native collateralization process. 

Possible complications include massive myocardial infarction due to retrograde flow around the occlusion balloon, complete heart block, ventricular fibrillation, stroke, dissection of the left anterior descending artery, and right coronary artery thrombosis. Though high grade atrioventricular blockage occurs relatively frequently, procedural mortality rate is low (0-4%) and severe complications are rare and often avoidable (7-10). 

Fig. 19 Nitroblue tetrazolium stained heart sections of rabbits with acute myocardial infarction treated with PL (left panel), saline placebo (middle panel) and IL (right panel). The sites of left circumflex coronary artery occlusion can be seen in the middle and right panels to be at the 4th slices by the presence of the silk sutures. Normal myocardium is stained purple or brown, whereas the infarcted regions remain as light colored regions.

Bairey CN, Shah PK, Lew AS, Hulse S. Electrocardiographic differentiation of occlusion of the left circumflex versus the right coronary artery as a cause of inferior acute myocardial infarction. Am J Cardiol 1987 60 456. 

ECG Discrimination Between Right and Left Circumfiex Coronary Arterial Occlusion in Patients V (ith Acute Inferior Myocardial Infarction... 

Gupta A, Lokhandwala YY, Kerkar PC, et al. Electrocardiographic differentiation between right coronary and left cir-curnflex coronary arterial occlusion in isolated inferior wall myocardial infarction. Indian Heart J 1999 51 281-284... 

In Fig. 2.2, the PET perfusion images show severe stenosis or occlusion of the left circumflex (LCx) and right (RCA) coronary arteries with a moderately severe stenosis of the left anterior descending (LAD) coronary artery proximal to its second diagonal branch. The ejection fraction (EF) and regional LV contraction were normal. Therefore, this example illustrates purely ischemic myocardium without scar and without injured or poorly contracting myocardium. 

Fig. 2.2 Positron emission tomography (PET) perfusion images showing severe stenosis/ occlusion of the left circumflex (LCx) and right (RCA) coronary arteries with...

Abbreviations ACS, acute coronary syndrome ACT, activated clotting time BP, blood pressure CTO, chronic total occlusion i.v., intravenous MI, myocardial infarction NSTEMI, non-ST-segment elevation myocardial infarction PCI, percutaneous coronary intervention RCA, right coronaiy artery STEMI, ST-segment elevation myocardial ... 

In the hospital, ECG and laboratory tests are performed promptly to determine the subsequent treatment strategy. When car-diomyocytes die, contractile proteins (troponin) or myocardial enzymes (creatine kinase, CK-MB) are liberated and can be detected in blood for diagnostic purposes. Marked elevation of the ST segment in the ECG raises the strong suspicion of a complete occlusion of a coronary artery (ST elevation MI, STEMI). In these MI patients, reperfusion of the affected area as early and as completely as Luellmann, Color Atlas of Pharmacology All rights reserved. Usage subject to terms... 

Huey B, Beller G, Kaiser O, Gibson R. A comprehensive analysis of myocardial infarction due to left circumflex artery occlusion comparison with infarction due to right coronary and left anterior descending artery occlusion. J Am Coll Cardiol 1988 12 1156. 

Figure 4.11 In an acute coronary syndrome with ST-segment elevation in II, III and VF as the most striking abnormality, the study of the ST-segment elevation and depression in different leads will allow us to assure if the occluded artery is RCA or LCX and even the site of the occlusion and its anatomical characteristics (dominance, etc ). This figure shows that the presence of ST-segment depression in lead I means that this lead is facing the injury vector tail that is directed to the right and, therefore, the...

Fig. 7-7. Gross view of thrombosis in aorta and carotid artery upper). Coronary occlusion by thrombosis, gross (right) and low power microscopy (left)...

---