Sandbox:Mitra3

Therapuetic Considerations in RVMI

Reperfusion

Maintenance of RV preload

Decreased RV afterload

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Inotropic support

Mechanical Circulatory Support

•Thrmobolytics •Percutaneous coronary intervention (PCI)

• Avoidance of preload reducing agents, such as: ❑Nitrates ❑Diuretics ❑Morphin • In patients with hypotension (without pulmonary congestion): ❑ Intravenous administration of Fluids (N/S 0.9% at 40mL for 2L, to maintain CVP <15mmHg and PCWP between 18-24 mmHg)

• Systemic or pulmonary vasodilators: ❑Nitrosrusside ❑Inhaled nitric oxide<be>

• In patients with bradyarrhthmias: ❑Atropine ❑Pacemaker • In patients with atrioventricular block: ❑Temporary dual-chamber pacemaker

• In patients with refractory hypotension: ❑Dobutamine (along with fluids) ❑Other inotropes: milrinone norepinephrine

May be needed in patients with cardiogenic shock secondary to RVMI: ❑Direct RV support ❑Indirect RV support ❑Biventricular support

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