Infarction of the right atrium occurs more often than it is recognized, often in the setting of a ventricular infarct. Wong et al described a tetrad of findings seen in a patient with an isolated right atrial infarct associated with disease in the sinus node artery. The authors are from Loma Linda University in Loma Linda, California.


Tetrad of findings for an isolated infarct of the right atrium:

(1) chest discomfort or pain

(2) paroxysmal supraventricular arrhythmia

(3) deviation in the PR segment (P-Ta) from the isoelectric baseline, usually in II, III, V2, V3 or V4

(4) elevation of cardiac enzymes consistent with myocardial infarction AND no evidence of ventricular infarction


The presence of a low atrial rhythm, especially upon reversion from a paroxysmal supraventricular tachyarrhythmia, should prompt an evaluation for atrial infarction.


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