Electrocardiographic picture of acute anterior infarction due to proximal obstruction of the right coronary artery.

Proximal occlusion of the right coronary artery may, in certain circumstances, cause elevation on the anterior wall leads. This can occur more easily when the size of the lesion in the inferior wall is small compared to that in the right ventricle. The size distribution of the elevations in the above leads is different from that seen when the anterior descending branch is occluded. More rarely, isolated right ventricular infarctions on a substrate of a non-dominant right coronary artery can cause elevations exclusively on the anterior wall leads, with no ECG changes in the inferior leads. We describe the case of an acute myocardial infarction with isolated elevations on the anterior wall leads, with no accompanying changes in the inferior leads, where the lesion responsible was acute proximal occlusion of the right coronary artery.