Importance of bedside echocardiography for detection of unsuspected isolated right ventricular infarction as a cause of cardiovascular collapse

Isolated right ventricular infarction is a rare and commonly overlooked condition, because of scarce electrocardiographic changes. We present 2 cases of isolated right ventricular infarction that went unrecognized in the ED. Both patients presented with signs of circulatory collapse, third-degree atrioventricular block, and without prominent ischemic changes in the electrocardiogram. Diagnosis was further obfuscated by the absence of chest pain and atypical clinical presentation with left-hand paresis in one patient and hypothermia in the second. Echocardiography was performed as part of the evaluation of unexplained hypotension. In both cases, it revealed right ventricular dysfunction, which suggested possible acute right ventricular infarction. Diagnosis was confirmed by the finding of subtotal ostial thrombotic occlusions of the right coronary artery in both cases. Echocardiography played a decisive role in the diagnostic procedure, enabling prompt therapeutic intervention and subsequent resolution of shock.