Chest pain with elevated ST segment in lead V1: a case report.

Isolated right ventricular infarction (RVI) is an underrecognized clinical entity that often mimics anteroseptal myocardial infarction due to its characteristic ST-segment elevation (STE) in precordial leads. We report the case of a 55-year-old man who presented with acute chest pain and STE in leads V1 and V2. Despite typical anteroseptal infarction patterns, the electrocardiogram (ECG) revealed decremental STE (V1 > V2), concomitant STE in lead III, and reciprocal ST depression in lateral leads. Coronary angiography confirmed proximal occlusion of the non-dominant right coronary artery. This case highlights the diagnostic challenges of isolated RVI and underscores key ECG features that distinguish it from anteroseptal infarction. Early recognition is imperative to avoid detrimental therapies (e.g., vasodilators) and to prioritize reperfusion and preload optimization.