Silent inferior myocardial infarction with extensive right ventricular scarring

Right ventricular infarction (RVI) occurs in approximately 50% of patients with inferior myocardial infarction (MI). The assessment of RVI is important for identifying patients being at increased risk of in hospital mortality and poorer prognosis if impaired right ventricular (RV) systolic function is present. We report the case of an asymptomatic 38-year-old male who sustained a silent inferior myocardial infarction with extensive RV involvement. There was no history of myocardial ischemia and cardiovascular risk factors. Therefore, first cardiac magnetic resonance (CMR) imaging using delayed enhancement (DE) was performed and revealed a transmural inferior wall myocardial infarction of LV with extensive involvement of RV. This case illustrates the difficulties of conventional imaging modalities and invasive coronary angiography to depict an inferior myocardial infarction with RV involvement.