European Heart Journal - Cardiovascular Imaging Advance Access published September 19, 2014
IMAGE FOCUS
doi:10.1093/ehjci/jeu186
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Right ventricular myocardial infarction: an underrecognized aetiology of McConnell’s sign Parth Shah, John William Schleifer, Farouk Mookadam, and Krishnaswamy Chandrasekaran* Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, Scottsdale, AZ 85054, USA
* Corresponding author. Tel: +1 480 342 2376; Fax: +1 480 342 2269. Email: [email protected]
A 71-year-old hypertensive male presented with presyncope leading to frequent falls in the 3 days prior to presentation. Electrocardiogram revealed sinus rhythm, third-degree atrioventricular block, and an inferior ST elevation myocardial infarction (MI; Panel A). Coronary angiography showed total occlusion of the right coronary artery (RCA; arrow; Panel B), and three drug-eluting stents were placed in the RCA (Panel C). Transthoracic echocardiography (TTE) demonstrated a moderate decrease in the systolic function of both the right ventricle (RV) and the left ventricle (LV) with a left ventricular ejection fraction of 33%. TTE further displayed McConnell’s sign in addition to regional wall motion abnormality of the inferior wall of the LV and RV (see Supplementary data online, Videos S1 and S2). A hypokinetic to akinetic RV free wall with normal or hyperdynamic motion of the RV apex is characteristic of McConnell’s Sign. Akinesia of the base and mid-free wall of the RV (asterisks) with hyperdynamic motion of the RV apex (arrow) was seen on the echo of our patient (see Supplementary data online, Video S1). Note the RV apex in diastole (Panel D) and systole (Panel E). Two-chamber view of the LV during diastole (Panel F) and systole (Panel G) demonstrates an akinetic inferior wall (asterisks; see Supplementary data online, Video S2). McConnell’s sign in our patient is from an inferior MI with RV MI. Therefore, McConnell’s sign, a sign of regional variation in RV strain that is often diagnostic of pulmonary embolism, should also alert for a RV MI. Conflict of interest: This submission is not under consideration elsewhere nor have any of the contents been previously published. All outlined authors have read and approved the manuscript, and none of the authors have any relationship with industry to disclose. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
IMAGE FOCUS
doi:10.1093/ehjci/jeu186
.............................................................................................................................................................................
Right ventricular myocardial infarction: an underrecognized aetiology of McConnell’s sign Parth Shah, John William Schleifer, Farouk Mookadam, and Krishnaswamy Chandrasekaran* Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, Scottsdale, AZ 85054, USA
* Corresponding author. Tel: +1 480 342 2376; Fax: +1 480 342 2269. Email: [email protected]
A 71-year-old hypertensive male presented with presyncope leading to frequent falls in the 3 days prior to presentation. Electrocardiogram revealed sinus rhythm, third-degree atrioventricular block, and an inferior ST elevation myocardial infarction (MI; Panel A). Coronary angiography showed total occlusion of the right coronary artery (RCA; arrow; Panel B), and three drug-eluting stents were placed in the RCA (Panel C). Transthoracic echocardiography (TTE) demonstrated a moderate decrease in the systolic function of both the right ventricle (RV) and the left ventricle (LV) with a left ventricular ejection fraction of 33%. TTE further displayed McConnell’s sign in addition to regional wall motion abnormality of the inferior wall of the LV and RV (see Supplementary data online, Videos S1 and S2). A hypokinetic to akinetic RV free wall with normal or hyperdynamic motion of the RV apex is characteristic of McConnell’s Sign. Akinesia of the base and mid-free wall of the RV (asterisks) with hyperdynamic motion of the RV apex (arrow) was seen on the echo of our patient (see Supplementary data online, Video S1). Note the RV apex in diastole (Panel D) and systole (Panel E). Two-chamber view of the LV during diastole (Panel F) and systole (Panel G) demonstrates an akinetic inferior wall (asterisks; see Supplementary data online, Video S2). McConnell’s sign in our patient is from an inferior MI with RV MI. Therefore, McConnell’s sign, a sign of regional variation in RV strain that is often diagnostic of pulmonary embolism, should also alert for a RV MI. Conflict of interest: This submission is not under consideration elsewhere nor have any of the contents been previously published. All outlined authors have read and approved the manuscript, and none of the authors have any relationship with industry to disclose. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
