A Right Turn in Diagnosis: Highlighting the Importance of TAPSE in Isolated Right Ventricular Myocardial Infarction
Bibliographic record
Abstract
Isolated right ventricular myocardial infarction (RVMI) is a rare but significant clinical entity that can present with atypical findings on a standard electrocardiograph (ECG). We present the case of a 65-year-old man with a history of chronic smoking and alcohol use who presented to the emergency department with acute chest pain. An initial ECG showed ST-segment elevation in lead V1 and depression in leads I, aVL, and V2-V6, which did not meet ST-segment elevation myocardial infarction (STEMI) criteria. A right-sided ECG revealed ST-segment elevation in V3R-V6R, concerning for RVMI. Notably, cardiac point of care ultrasound (POCUS) demonstrated normal left ventricular (LV) function without LV or right ventricular (RV) regional wall motion abnormalities (RWMA). However, tricuspid annular plane systolic excursion (TAPSE) was significantly reduced at 1 cm, indicating RV dysfunction despite the absence of RWMA. This is the first known case report that highlights the importance of TAPSE in assessing RV function in isolated RVMI cases. Early recognition and management are crucial, especially in patients with typical presentations, as prompt treatment can prevent complications. This case underscores the need for emergency physicians to maintain a high index of suspicion for RVMI, particularly in atypical presentations, and to utilize cardiac POCUS as an essential tool for evaluation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".