Sandbox:Mitra: Difference between revisions
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==Do's== | ==Do's== | ||
* Right ventricular myocardial infarction should be | * [[Right ventricular myocardial infarction]] [[(RVMI)]] should be ruled out in all patients presenting with acute [[inferior wall myocardial infarction]], in particular in patients with [[hypotension]]. | ||
*In patients presenting with chest pain and clinical findings of hypotension, elevated JVP and clear lung fields consider the differential diagnoses of RVMI. These include: | *In patients presenting with [[chest pain]] and clinical findings of [[hypotension]], elevated [[JVP]] and clear lung fields, consider the differential diagnoses of [[RVMI]]. These include: | ||
**Pulmonary embolism | **[[Pulmonary embolism]] | ||
**Pericarditis with pericardial tamponade | **[[Pericarditis]] with [[pericardial tamponade]] | ||
*Systemic or pulmonary vasodilators may be considered in selected patients to reduce RV afterload, thereby improving cardiac output. | *Systemic or pulmonary [[vasodilators]] may be considered in selected patients to reduce [[RV afterload]], thereby improving [[cardiac output]]. | ||
*In patients with severe tricuspid regurgitation due to RVMI, replacement of tricuspid valve or repair of the valve with annuloplasty rings may be considered. | *In patients with severe [[tricuspid regurgitation]] due to [[RVMI]], replacement of [[tricuspid valve]] or repair of the valve with annuloplasty rings may be considered. | ||
*In patients with RVMI who have unexplained hypoxemia despite administration of 100% oxygen, right-to-left shunting -through a patent foramen ovale or atrial septal defect- | *In patients with [[RVMI]] who have unexplained [[hypoxemia]] despite administration of 100% oxygen, [[right-to-left shunting]] -through a [[patent foramen ovale]] or [[atrial septal defect]]-, caused by the disproportionate elevation in right-sided filling pressures compared to the normal or slightly increased left-sided filling pressures should be considered. | ||
*Patients with extensive RVMI may be at higher risk of right ventricular perforation during interventional procedures. | *Patients with extensive [[necrosis]] due to [[RVMI]] may be at higher risk of right ventricular perforation during interventional procedures. [[Right ventricular catheterization]] or [[pacemaker]] insertion should be performed with great care in these patients. | ||
==Don'ts== | ==Don'ts== | ||
* In patients with RVMI, avoid preload-reducing agents such as nitrates, diuretics, morphine, beta-blockers, and calcium channel blockers. | * In patients with RVMI, avoid preload-reducing agents such as nitrates, diuretics, morphine, beta-blockers, and calcium channel blockers. | ||
Revision as of 14:26, 2 August 2020
Do's
- Right ventricular myocardial infarction (RVMI) should be ruled out in all patients presenting with acute inferior wall myocardial infarction, in particular in patients with hypotension.
- In patients presenting with chest pain and clinical findings of hypotension, elevated JVP and clear lung fields, consider the differential diagnoses of RVMI. These include:
- Systemic or pulmonary vasodilators may be considered in selected patients to reduce RV afterload, thereby improving cardiac output.
- In patients with severe tricuspid regurgitation due to RVMI, replacement of tricuspid valve or repair of the valve with annuloplasty rings may be considered.
- In patients with RVMI who have unexplained hypoxemia despite administration of 100% oxygen, right-to-left shunting -through a patent foramen ovale or atrial septal defect-, caused by the disproportionate elevation in right-sided filling pressures compared to the normal or slightly increased left-sided filling pressures should be considered.
- Patients with extensive necrosis due to RVMI may be at higher risk of right ventricular perforation during interventional procedures. Right ventricular catheterization or pacemaker insertion should be performed with great care in these patients.
Don'ts
- In patients with RVMI, avoid preload-reducing agents such as nitrates, diuretics, morphine, beta-blockers, and calcium channel blockers.