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==Overview ==   
==Overview ==   
[[Acute myocardial infarction]] involving only the free wall of the [[right ventricle]] is a rare event <ref>Anderson, HR, Falk, E, Nielsen, D. Right ventricular infarction: Frequency, size, and topography in coronary heart disease. J Am Coll Cardiol 1987; 10:1223. PMID 3680789</ref>  More commonly, [[Right ventricular myocardial infarction|right ventricular infarction]] is associated with infarction of the inferior wall of the left ventricle, occurring in more than one-third of such cases <ref>Anderson, HR, Falk, E, Nielsen, D. Right ventricular infarction: Frequency, size, and topography in coronary heart disease. J Am Coll Cardiol 1987; 10:1223. PMID 3680789</ref> <ref>Isner, JM, Roberts, WC. Right ventricular infarction complicating left ventricular infarction secondary to coronary artery disease: frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. Am J Cardiol 1978; 42:885. PMID 153103</ref> <ref>Isner, JM. Right ventricular myocardial infarction. JAMA 1988; 259:712. PMID 3275819</ref>  <ref>Williams, JF. Right ventricular infarction. Clin Cardiol 1990; 13:309. PMID 2189611</ref> <ref>Cabin, HS, Clubb, S, Wackers FJ, et al. Right ventricular myocardial infarction with anterior wall left ventricular infarction: an autopsy study. Am Heart J 1987; 113:16. PMID 3799430</ref> <ref>Kinch, JW, Ryan, TJ. Right ventricular infarction. N Engl J Med 1994; 330:1211. PMID 8139631</ref> <ref>Setaro, JF, Cabin, HS. Right ventricular infarction. Cardiol Clin 1992; 10:69. PMID 1739961</ref> <ref>Cohn, JN. Right ventricular infarction revisited. Am J Cardiol 1979; 43:666. PMID 420117</ref> <ref>Wackers, FJ, Lie, KI, Sokole, EB, et al. Prevalence of right ventricular involvement in inferior wall infarction associated with myocardial imaging with thallium-201 and technetium-99m pyrophosphate. Am J Cardiol 1978; 42:358. PMID 210648</ref>, even when thrombolytic therapy is given <ref>Zeymer, U, Neuhaus, K-L, Wegscheider, K, et al. Effects of thrombolytic therapy in acute inferior myocardial infarction with and without right ventricular involvement. J Am Coll Cardiol 1998; 32:876. PMID 9768705</ref>.
[[Acute myocardial infarction]] involving only the free wall of the [[right ventricle]] is a rare event. <ref>Anderson, HR, Falk, E, Nielsen, D. Right ventricular infarction: Frequency, size, and topography in coronary heart disease. J Am Coll Cardiol 1987; 10:1223. PMID 3680789</ref>  More commonly, [[Right ventricular myocardial infarction|right ventricular infarction]] is associated with infarction of the inferior wall of the left ventricle, occurring in more than one-third of such cases,<ref>Anderson, HR, Falk, E, Nielsen, D. Right ventricular infarction: Frequency, size, and topography in coronary heart disease. J Am Coll Cardiol 1987; 10:1223. PMID 3680789</ref> <ref>Isner, JM, Roberts, WC. Right ventricular infarction complicating left ventricular infarction secondary to coronary artery disease: frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. Am J Cardiol 1978; 42:885. PMID 153103</ref> <ref>Isner, JM. Right ventricular myocardial infarction. JAMA 1988; 259:712. PMID 3275819</ref>  <ref>Williams, JF. Right ventricular infarction. Clin Cardiol 1990; 13:309. PMID 2189611</ref> <ref>Cabin, HS, Clubb, S, Wackers FJ, et al. Right ventricular myocardial infarction with anterior wall left ventricular infarction: an autopsy study. Am Heart J 1987; 113:16. PMID 3799430</ref> <ref>Kinch, JW, Ryan, TJ. Right ventricular infarction. N Engl J Med 1994; 330:1211. PMID 8139631</ref> <ref>Setaro, JF, Cabin, HS. Right ventricular infarction. Cardiol Clin 1992; 10:69. PMID 1739961</ref> <ref>Cohn, JN. Right ventricular infarction revisited. Am J Cardiol 1979; 43:666. PMID 420117</ref> <ref>Wackers, FJ, Lie, KI, Sokole, EB, et al. Prevalence of right ventricular involvement in inferior wall infarction associated with myocardial imaging with thallium-201 and technetium-99m pyrophosphate. Am J Cardiol 1978; 42:358. PMID 210648</ref> even when a thrombolytic therapy is given. <ref>Zeymer, U, Neuhaus, K-L, Wegscheider, K, et al. Effects of thrombolytic therapy in acute inferior myocardial infarction with and without right ventricular involvement. J Am Coll Cardiol 1998; 32:876. PMID 9768705</ref>


One study of 113 patients with a first acute inferior wall infarction reported that the presence of preinfarction angina within 72 hours of the infarction was associated with a reduction in the incidence of right ventricular infarction (odds ratio 0.2) and combined hypotension and shock (odds ratio 0.1) <ref>Shiraki, H, Yoshikawa, T, Anzai, T, et al. Association between preinfarction angina and a lower risk of right ventricular infarction. N Engl J Med 1998; 338:941. PMID 9521981</ref>. This is possibly the result of ischemic preconditioning.  
One study of 113 patients with a first acute inferior wall infarction reported that the presence of preinfarction [[angina]] within 72 hours of the infarction was associated with a reduction in the incidence of right ventricular infarction (odds ratio 0.2) and combined [[hypotension]] and [[shock]] (odds ratio 0.1). <ref>Shiraki, H, Yoshikawa, T, Anzai, T, et al. Association between preinfarction angina and a lower risk of right ventricular infarction. N Engl J Med 1998; 338:941. PMID 9521981</ref> This is possibly the result of ischemic preconditioning.  


* Ninety percent of [[Right ventricular myocardial infarction|right ventricular infarcts]] result from occlusion of the proximal right coronary artery, while another 5 to 10 percent arise after occlusion of the left anterior descending artery <ref>Isner, JM, Roberts, WC. Right ventricular infarction complicating left ventricular infarction secondary to coronary artery disease: frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. Am J Cardiol 1978; 42:885.PMID 153103</ref> <ref>Isner, JM. Right ventricular myocardial infarction. JAMA 1988; 259:712. PMID 3275819 </ref> <ref>Williams, JF. Right ventricular infarction. Clin Cardiol 1990; 13:309. PMID 2189611</ref> <ref>Cabin, HS, Clubb, S, Wackers FJ, et al. Right ventricular myocardial infarction with anterior wall left ventricular infarction: an autopsy study. Am Heart J 1987; 113:16. PMID 3799430</ref>  
* Ninety percent of [[Right ventricular myocardial infarction|right ventricular infarcts]] result from occlusion of the proximal right coronary artery, while another 5 to 10 percent arise after occlusion of the left anterior descending artery <ref>Isner, JM, Roberts, WC. Right ventricular infarction complicating left ventricular infarction secondary to coronary artery disease: frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. Am J Cardiol 1978; 42:885.PMID 153103</ref> <ref>Isner, JM. Right ventricular myocardial infarction. JAMA 1988; 259:712. PMID 3275819 </ref> <ref>Williams, JF. Right ventricular infarction. Clin Cardiol 1990; 13:309. PMID 2189611</ref> <ref>Cabin, HS, Clubb, S, Wackers FJ, et al. Right ventricular myocardial infarction with anterior wall left ventricular infarction: an autopsy study. Am Heart J 1987; 113:16. PMID 3799430</ref>  
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[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Intensive care medicine]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]


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Latest revision as of 14:57, 20 September 2012

Right ventricular myocardial infarction Microchapters

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Overview

Pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Acute myocardial infarction involving only the free wall of the right ventricle is a rare event. [1] More commonly, right ventricular infarction is associated with infarction of the inferior wall of the left ventricle, occurring in more than one-third of such cases,[2] [3] [4] [5] [6] [7] [8] [9] [10] even when a thrombolytic therapy is given. [11]

One study of 113 patients with a first acute inferior wall infarction reported that the presence of preinfarction angina within 72 hours of the infarction was associated with a reduction in the incidence of right ventricular infarction (odds ratio 0.2) and combined hypotension and shock (odds ratio 0.1). [12] This is possibly the result of ischemic preconditioning.

  • Ninety percent of right ventricular infarcts result from occlusion of the proximal right coronary artery, while another 5 to 10 percent arise after occlusion of the left anterior descending artery [13] [14] [15] [16]

Although more than one-third of cases are clinically silent [17], the presence of right ventricular infarction often has important implications for both management and prognosis.

References

  1. ↑ Anderson, HR, Falk, E, Nielsen, D. Right ventricular infarction: Frequency, size, and topography in coronary heart disease. J Am Coll Cardiol 1987; 10:1223. PMID 3680789
  2. ↑ Anderson, HR, Falk, E, Nielsen, D. Right ventricular infarction: Frequency, size, and topography in coronary heart disease. J Am Coll Cardiol 1987; 10:1223. PMID 3680789
  3. ↑ Isner, JM, Roberts, WC. Right ventricular infarction complicating left ventricular infarction secondary to coronary artery disease: frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. Am J Cardiol 1978; 42:885. PMID 153103
  4. ↑ Isner, JM. Right ventricular myocardial infarction. JAMA 1988; 259:712. PMID 3275819
  5. ↑ Williams, JF. Right ventricular infarction. Clin Cardiol 1990; 13:309. PMID 2189611
  6. ↑ Cabin, HS, Clubb, S, Wackers FJ, et al. Right ventricular myocardial infarction with anterior wall left ventricular infarction: an autopsy study. Am Heart J 1987; 113:16. PMID 3799430
  7. ↑ Kinch, JW, Ryan, TJ. Right ventricular infarction. N Engl J Med 1994; 330:1211. PMID 8139631
  8. ↑ Setaro, JF, Cabin, HS. Right ventricular infarction. Cardiol Clin 1992; 10:69. PMID 1739961
  9. ↑ Cohn, JN. Right ventricular infarction revisited. Am J Cardiol 1979; 43:666. PMID 420117
  10. ↑ Wackers, FJ, Lie, KI, Sokole, EB, et al. Prevalence of right ventricular involvement in inferior wall infarction associated with myocardial imaging with thallium-201 and technetium-99m pyrophosphate. Am J Cardiol 1978; 42:358. PMID 210648
  11. ↑ Zeymer, U, Neuhaus, K-L, Wegscheider, K, et al. Effects of thrombolytic therapy in acute inferior myocardial infarction with and without right ventricular involvement. J Am Coll Cardiol 1998; 32:876. PMID 9768705
  12. ↑ Shiraki, H, Yoshikawa, T, Anzai, T, et al. Association between preinfarction angina and a lower risk of right ventricular infarction. N Engl J Med 1998; 338:941. PMID 9521981
  13. ↑ Isner, JM, Roberts, WC. Right ventricular infarction complicating left ventricular infarction secondary to coronary artery disease: frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. Am J Cardiol 1978; 42:885.PMID 153103
  14. ↑ Isner, JM. Right ventricular myocardial infarction. JAMA 1988; 259:712. PMID 3275819
  15. ↑ Williams, JF. Right ventricular infarction. Clin Cardiol 1990; 13:309. PMID 2189611
  16. ↑ Cabin, HS, Clubb, S, Wackers FJ, et al. Right ventricular myocardial infarction with anterior wall left ventricular infarction: an autopsy study. Am Heart J 1987; 113:16. PMID 3799430
  17. ↑ Wackers, FJ, Lie, KI, Sokole, EB, et al. Prevalence of right ventricular involvement in inferior wall infarction associated with myocardial imaging with thallium-201 and technetium-99m pyrophosphate. Am J Cardiol 1978; 42:358. PMID 210648

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