Giant R-waves in a patient with an acute inferior myocardial infarction

We describe a case of a male patient with "giant" R-waves (GRWs) in association with an acute inferior myocardial infarction (MI). Such electrocardiogram (ECG) pattern has been associated heretofore with the hyperacute phase of an anterior MI, and unstable, and variant angina, although it is found in illustrations of many previous publications in conjunction with inferior MI. The GRWs, along with ST-segment elevations, were noted transiently in the inferior ECG leads, early in the clinical course of our patient. Subsequent evolution of the ECG revealed classic appearances for an inferior MI. Cardiac enzymes, and thallium-201 myocardial perfusion scintigraphy revealed evidence for inferiorly-located myocardial necrosis. Coronary arteriography showed stenosis of the right coronary artery, for which the patient underwent an uneventful angioplasty and "stenting" of the culprit vessel. The pathophysiology of the syndrome of GRWs is briefly discussed.