Isolated right ventricular ischemia in combination with myocardial infarcti
on (MI) is uncommon, accounting for fewer than 3% of all MI cases. A young
man who presented with acute right ventricular ischemia from occlusion of a
codominant right coronary artery proximal to an acute marginal branch is p
resented. His presenting electrocardiogram (ECG) showed ST segment elevatio
n in V-1 to V-4 mimicking acute anterior MI. ECG criteria for isolated righ
t ventricular ischemia are discussed.