A 45-year-old man was admitted to hospital 8 hours after the onset of an acute myocardial infarction (AMI). He reported sustained chest pain but did not have congestive heart failure. Admission electrocardiogram showed inferior Q waves and diffuse ST elevation with ST depression in the right precordial lead ( Fig. 1 ). Coronary angiography was performed immediately and identified three-vessel disease with right coronary occlusion. The culprit artery was reperfused successfully using 100 mL of contrast. Sixty-four detector computed tomography (CT) performed 10 minutes after angioplasty without additional contrast showed transmural inferior left ventricular (LV) myocardial hyperenhancement with right ventricular (RV) involvement ( Fig. 2 A ). Over the following 2 days the patient exhibited multiple ventricular arrhythmias. Echocardiography showed inferior RV and LV akinesia without RV enlargement. Cardiac magnetic resonance (CMR) imaging performed before discharge at day 6 confirmed the same myocardial hyperenhancement in both ventricles ( Fig. 2 B).
