Syncope as the sole manifestation of acute right ventricular myocardial infarction in a non-diabetic patient

Syncope is a symptom defined as a transient, self-limited loss of consciousness, usually leading to a fall. The causes of syncope are numerous, but life-threatening conditions should be identified as the first priority in order to avoid a catastrophic outcome. Here we report a non-diabetic patient who presented syncope as the sole manifestation of a silent acute right ventricular myocardial infarction (RVMI). The cause of syncope in this patient was assumed to be hypoperfusion of sinus node artery arising from the right coronary artery, hence causing transient sinus node dysfunction. Syncope could be the sole manifestation of RVMI complicated with sinus node dysfunction. Lead II in ECG monitoring itself could only provide limited information and a panel of 12-lead ECG is required in all patients presenting with syncope, even in the absence of typical symptoms of acute coronary syndrome or hemodynamic instability. Continuous ECG monitoring and prolonged ED observation in a syncopal patient without immediately identifiable causes is warrant to avoid such potentially life-threatening condition.