Right ventricular infarction (original) (raw)

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 myocardial infarction: pathophysiology, diagnosis, and management

Postgraduate Medical Journal, 2010

Right ventricular (RV) ischaemia complicates up to 50% of inferior myocardial infarctions (MIs), though isolated RV myocardial infarction (RVMI) is extremely rare. Although the RV shows good long term recovery, in the short term RV involvement portends a worse prognosis to uncomplicated inferior MI, with haemodynamic and electrophysiologic complications increasing in-hospital morbidity and mortality. Acute RV shock has an equally high mortality to left ventricular (LV) shock. Identification of RV involvement, particularly in the setting of hypotension, can help anticipate and prevent complications and has important management implications which are distinct from the management of patients presenting with LV infarction. Reperfusion therapy, particularly by primary percutaneous coronary intervention, hastens and enhances RV functional recovery that occurs to near normality in most patients. The diagnostic methods for RVMI are discussed, including clinical, electrocardiographic, and various imaging modalities as well as the RV pathophysiology that underpins the specifics of RVMI management.

[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.

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.

Jugular venous pressure and pulse wave form in the diagnosis of right ventricular infarction

International Journal of Cardiology, 1996

Jugular venous pressure (measured clinically) and pulse wave form (recorded at 100 mm/s) were analysed in 44 cases of first acute myocardiai infarction and 10 age-matched controls. Patients were divided into different groups according to site of infarction decided by detailed 2-D echocardiography. Raised jugular venous pressure had high specificity (96.8%) but low sensitivity (39%) in diagnosing right ventricular infarction. Positive Kussmaul's sign had equal specificity but lower sensitivity (26.1%). Rapid 'y' descent had high specificity (100%) but low sensitivity (17.3%) in diagnosing right ventricular infarction. Jugular venous pressure and pulse wave form are significantly affected by the magnitude of damage to interventricular septum and left ventricular free wall.

Left ventricular diastolic function in acute myocardial infarction: advantages and limitations

Cardiologia Croatica, 2013

Background: Modern approach to evaluation of left ventricular diastolic function should be based on determining the value of left ventricular filling pressures, which are the actual parameters of the symptoms and/or signs and prognosis in acute myocardial infarction. Aim: Compare parameters of left ventricular filling pressure in patients with acute myocardial infarction (AMI) with anteroseptal and inferior localization. Methods: Prospective study of 60 patients (37 men, mean age 59 ±10 years) with acute myocardial infarction were divided into two groups. The first group consists of patients with myocardial infarction, anteroseptal localization (27 patients) and the second group consists of patients with myocardial infarction inferior localization (33 patients). Accompanied by the ratio of early diastolic filling velocity of mitral flow velocity and early mitral annular filling (E/E'), the difference between the duration of flow reversal in the pulmonary veins and duration of the mitral A wave flow (PVA-MVAdur), and the relative velocity of early diastolic filling mitral flow and color M mode display of early mitral flow (E/Vp) of the left ventricle as determined by continuous (mitral flow) and pulsed color Doppler echocardiographic technique (flow in the pulmonary veins and the mitral ring velocities). Results: The value of E/E' ≥13 was found in 14 patients (8 patients in the first group, and 6 patients in the second group), while the value of 8 <E/E' <13 in 25 patients. The value of E/E '<8 was found in 21 patients. The average value of Avg=E/E' for the first group of patients was Avg=10.87 and the second group of subjects was Avg=9.39 was found to be a statistically significant difference (p <0.05) between the two groups, using the Student's t-test. Using Pearson's correlation coefficient we found that there was a significant correlation between E/E' and E/Vp in all patients (P = 0.66), whereas there was no difference in the correlation of these two proposed relationships between groups (P = 0.70 and P = 0.67). When comparing the ratio E/E' and PVA-MVAdur and E/Vp and PVA-MVAdur, Pearson correlation coefficient at a given group of 60 subjects showed no statistically significant correlation of this data. For PVA-MVAdur Pearson correlation coefficient has medium correlation compared to infarcted zone with inferior localization for the patients with E/E' ≥13. Conclusions: Comparison of parameters of yhe left ventricular filling pressures, it is proved that the left ventricular filling pressures in acute myocardial infarction is increased. There is a high correlation between the filling pressures and infarcted zone in the AMI anteroseptal localization in relation to the inferior localization of E/E' and E/Vp.

Clinical manifestations of right ventricle involvement in inferior myocardial infarction

Caspian Journal of Internal Medicine, 2014

Background: Early diagnosis of right ventricle (RV) involvement in inferior myocardial infarction (Inf MI) is very critical. This study was performed to evaluate the clinical findings of Inf MI with or without RV infarction. Methods: From September 2010 to September 2012, 195 patients with definite diagnosis of Inf MI were evaluated in the Department of Cardiology, in Babol, north of Iran. The presence or absence of right ventricular infarction was evaluated by ST elevation in preicordial V3R-V4R leads. Chest pain (CP), changes in electrocardiography (ECG), serum level of Troponin T (TnT), decreased level of consciousness, hypotension, and jugular vein prominence (JVP) in patients with and without RV involvement were noted. Results: One hundred forty eight (95 males and 53 females) and 47 (31 males and 16 females) cases developed Inf MI without and with RV infarction, respectively. The mean age of the patients with and without RV infarction were 60.59±12.9 and 60.9±12.2 years, respectively (P=0.883). CP, decreased consciousness, hypotension, and JVP were seen in 147 (99.3%), 1 (0.7%), 1 (0.7%) and 1 (0.7%) patients without RV involvement and in 44 (93.6%), 9 (19.1%), 27 (54.4%) and 9 (19.1) in RV involvement, respectively (p<0.05). No significant differences were seen in ThT enzymes and ECG changes. Conclusion: The results show that chest pain, decrease of consciousness, hypotension, JVP prominence are more frequent in inferior MI with RV involvement patients.