Right ventricular myocardial infarction: pathophysiology, diagnosis, and management (original) (raw)
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Clinical Cardiology, 1995
Little is known about the influence of right ventricular (RV) dysfunction on prognosis of patients with acute inferior myocardial infarction (IMI) and RV involvement. Therefore, 99 consecutive patients (mean age 56.6 ± 3.4 years) with RV involvement during acute IMI were followed for a 12-month period to clarify the influence of acute RV dysfunction on short- and long-term survivals. Forty-one patients with IMI evolved with severe arterial hypotension due to RV dysfunction, while 58 patients had no hemodynamic impairment due to RV involvement. Basal hemodynamic data (mean ± SD) for patients with RV dysfunction were blood pressure (BP) 92/59 ± 22/20 mmHg, systemic vascular resistance (SVR) 2314 ± 252 dynes·s·cm−5, and cardiac index (CI) 1.3 ± 0.31/min/m2. Patients without RV dysfunction demonstrated BP 113/74 ± 20/16 mmHg (p≤0.05), SVR 1324 ± 354 dynes·s·cm−5 (p≤0.01), and CI 2.6 ± 0.5 1/min/m2 (p≤0.05). Angiographic differences noted were that hemodynamically compromised patients showed lower RV ejection fractions (0.27 ± 0.08) than patients without hemodynamic disturbance [0.41 ± 0.11 (p≤0.05)]; however, left ventricular ejection fractions were 0.48 ± 0.10 and 0.52 ± 0.12, respectively. Short- and long-term mortality rates were assessed during the follow-up period. Patients with hemodynamic impairment due to RV infarction had a higher mortality rate for the first month and for 11 subsequent months post MI than patients without hemodynamic impairment, that is, 24.4 vs. 6.9 and 14.6 (p≤0.05) vs. 3.4% (p≤0.05), respectively. These data suggest that decreased RV ejection fraction possibly is linked with significantly reduced short- and long-term survival in patients with RV involvement during acute IMI.
Right ventricular stunning in inferior myocardial infarction
International Journal of Cardiology, 2009
Aim: To assess right ventricular (RV) function in patients with inferior myocardial infarction (IMI) and to observe changes following thrombolysis. Background: RV dysfunction occurs in 30% of patients with IMI. The extent of such involvement and its potential, recovery has not been determined. Methods: We studied 30 patients with acute IMI (age 56 ± 12 years), on admission, day 7 and day 30 post thrombolysis. No patient had clinical signs of RV failure. RV segmental function was assessed from free wall long axis and global function from filling and ejection velocities. Values were compared with 15 age-matched controls. Results: On admission, RV long axis amplitude, systolic and diastolic velocities were depressed (2.09 ± 0.39 vs 2.6 ± 0.3 cm, 8.18 ± 1.8 vs 10.0± 2.0 cm/s and 6.9 ± 2.7 vs 10.0± 2.5 cm/s, p b 0.01 for all) and global function impaired; reduced Z ratio (0.85 ± 0.07 vs 0.9 ± 0.04, p b 0.01), raised Tei index (0.49 ± 0.26 vs 0.3 ± 0.1, p b 0.001) and prolonged t-IVT (8.16 ± 3.9 vs 4.8 ± 2 s/m, p b 0.01) compared to controls.
[Myocardial infarction of the right ventricle]
Terapevticheskiĭ arkhiv, 1982
Right ventricular (RV) myocardial infarction (MI) usually occurs in the setting of an inferior MI (IMI) when the acute occlusion of the right coronary artery (RCA) is located proximally to the acute RV marginal branches, which commonly provide blood supply to the RV. RV MI may result in severe right heart failure with hemodynamic compromise and cardiogenic shock which distinctly differs from the cardiogenic shock secondary to left ventricular (LV) dysfunction, presenting with the clinical triad of low-output hypotension, clear lungs, and jugular venous distention despite intact global LV systolic function. The ECG provides further confirmation by examining the right precordial leads, V1 and more specifically V4R displaying ST elevation. Management of this type of cardiogenic shock is also grossly different from the management of LV shock requiring fluid resuscitation and/or vasopressors as the most important initial approach; however more definitive treatment is similar to any type of acute MI with prompt mechanical reperfusion therapy, most effectively achieved via primary percutaneous coronary intervention (PCI) of the culprit coronary artery occlusion.
Clinical correlates of acute right ventricular infarction in acute inferior myocardial infarction
International Journal of Cardiology, 1989
Right ventricular infarction was diagnosed on the basis of ST-segment elevation 2 1 mm in at least one right precordial lead (V,R-V,R) in 20 of 50 patients with first acute inferior myocardial infarction. Seventy five percent of these had ST elevation in 2 or more right precordial leads. Giddiness and hiccups were more common amongst such patients (P < 0.05). Signs of right ventricular dysfunction-raised jugular venous pressure (65%), Kussmaull's sign (45%), hypotension (without cardiogenic shock, 40%) and right-sided third sound (25%) in the absence of clinical left ventricular failure, were noted in 65% of such patients. Eleven patients had 2 or more of the above signs. ST elevation in 2 or more right precordial leads was found in 10 of these 11 patients. A more complicated course in the hospital characterised by bradyarrhythmias, hypotension and cardiogenic shock, combined with a greater mortality was seen in such patients. We conclude that the bedside diagnosis of haemodynamically significant right ventricular infarction can be made on the basis of a combination of clinical signs and ST elevation in 2 or more right precordial leads, even in units not equipped for bedside haemodynamic monitoring, echocardiography and radionuclide studies. This should lead to a better identification and management of such patients. inferior myocardial infarction [5] and when present may dominate the clinical picture and haemodynamic consequences. Secondly, its pres-India. ence not only means that appropriate therapy 0167-5273/89/$03.50 0 1989 Elsevier Science Publishers B.V. (Biomedical Division)
Right ventricular function in ST elevation myocardial infarction: Effect of reperfusion
Clinical & Investigative Medicine, 2009
Purpose: To investigate right ventricle function in successfully reperfused ST elevated myocardial infarction (STEMI) and to compare reperfusion strategies. Methods: From January 2007 to August 2008, 33 patients with anterior myocardial infarction (MI) and 48 patients with non-anterior myocardial infarction were enrolled in this study. Patients were treated with thrombolytic therapy (TT) or primary percutanaeous coronary intervention (PPCI) (Primary intervention: 16 and 25 patients (anterior and non-anterior consecutively), thrombolytic therapy: 17 and 23 patients (anterior and non-anterior consecutively)). Right ventricle (RV) function was analyzed using tissue Doppler investigation (TDI) after 72 hr of successful reperfusion. Results: There was no difference in right ventricle function assessed by right ventricle TDI Tei index between the PPCI and TT group (0.39±0.20 vs. 0.39±0,17). RV TDI Tei index increased in anterior MI patients treated with either PPCI or TT compared with con...
Coronary Artery Disease, 2002
Background The role of thrombolytic therapy (TT) and percutaneous coronary interventions (PCIs) in subgroups of patients with right ventricular infarction (RVI) has not been evaluated. Methods and Results We risk-stratified 302 patients with RVI into three subsets upon admission. Class A (n¼197) comprised patients without right ventricular (RV) failure, Class B (n¼69) with RV failure and Class C (n¼36) with cardiogenic shock. All eligible patients in Class A or B received either PCI or TT. Patients in Class C eligible for reperfusion were treated with PCI. All patients were evaluated for in-hospital major adverse cardiac events and short-term mortality. There was a statistically significant difference in in-hospital mortality among the classes. Classes B and C were the strongest indicators of in-hospital mortality. By multivariate analysis TT or PCI did not reduce mortality in Classes A and B, but a clinically favorable trend in mortality reduction was documented: both methods decreased RV dysfunction in Class B (from 97 to 61% with TT and to 28% with PCI; P o 0.001) and PCI reduced the risk of mortality in Class C (89.5 compared with 58%; P o 0.05).
Right ventricular myocardial infarction in the era of primary percutaneous coronary intervention
Bratislavské lekárske listy, 2021
Right ventricular involvement (RVMI) is a relatively frequent complication in patients developing ST-elevation acute myocardial infarction. The initial diagnosis is most often established using electrocardiography or echocardiography. The gold standard among imaging techniques is cardiac magnetic resonance, which allows to distinguish between reversible and irreversible myocardial damage. The key treatment strategy is emergent revascularization by primary percutaneous coronary intervention whereas patients with hypotension and cardiogenic shock due to the RVMI require fl uid replacement and catecholamine therapy. In cases where the shock state progresses despite an adequate management, short-or, possibly, long-term mechanical assist device should be implanted either percutaneously or surgically. Despite appreciable advances in the diagnosis and management, RVMI remains an independent predictor of early as well as late complications
The American Journal of Cardiology, 2004
We evaluated right ventricular (RV) systolic and diastolic function in 30 patients with acute RV myocardial infarction on echocardiography. Systolic and diastolic function were impaired early in the setting of RV myocardial infarction, but improved significantly at 3 months. ᮊ2004 1. Kinch J, Ryan T. Right ventricular infarction. N Engl J Med 1994;330:1211-1217 2. Zehender M, Kasper W, Kauder E, Schonthaler M, Geibel A, Olschewski M, Just H. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993;328:981-988. 3. Mehta S, Eikelboom J, Natarajan M, Diaz R, Yi C, Gibbons R, Yusuf S. Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction. J Am Coll Cardiol 2001; 37:37-43. 4. Braat SH, Brugada P, De Zwaan C, Coenegracht JM, Wellens HJJ. Value of electrocardiogram in diagnostic right ventricular involvement in patients with an acute inferior wall myocardial infarction. Br Heart J 1983; 49:368 -372. 5. Goldstein JA, Barzilai B, Rosamond TL, Eisenberg PR, Jaffe AS. Determinants of hemodynamic compromise with severe right ventricular infarction. Circulation 1990;82:359 -368.