Right ventricular myocardial infarction echocardiography or ultrasound: Difference between revisions
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==Overview== | ==Overview== | ||
==Echocardiography== | |||
* Echocardiography may be limited in [[Right ventricular myocardial infarction|right ventricular infarction]] by suboptimal views of the right ventricle. In addition, interpretation of right ventricular function may be affected by coexistent pulmonary disease (such as [[Chronic obstructive pulmonary disease|obstructive lung disease]] or [[pulmonary embolism]]). | * Echocardiography may be limited in [[Right ventricular myocardial infarction|right ventricular infarction]] by suboptimal views of the right ventricle. In addition, interpretation of right ventricular function may be affected by coexistent pulmonary disease (such as [[Chronic obstructive pulmonary disease|obstructive lung disease]] or [[pulmonary embolism]]). | ||
* Despite these limitations, [[echocardiography]] is often a useful test that can be performed at the bedside when the diagnosis of [[Right ventricular myocardial infarction|right ventricular infarction]] is suspected. Right ventricular size | * Despite these limitations, [[echocardiography]] is often a useful test that can be performed at the bedside when the diagnosis of [[Right ventricular myocardial infarction|right ventricular infarction]] is suspected. Right ventricular size, function, and the degree (if any) of [[tricuspid insufficiency]] can all be evaluated. <ref>Zehender, M, Kasper, W, Kauder, E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328:981. PMID 8450875</ref> Useful information concerning left-sided structures and function can also be obtained. <ref>Zehender, M, Kasper, W, Kauder, E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328:981. PMID 8450875</ref><ref>Kahn, JK, Bernstein, M, Bengston, JR. Isolated right ventricular myocardial infarction. Ann Intern Med 1993; 118:708. PMID 8460858</ref> | ||
* Right ventricular peak systolic pressure may be estimated from the Doppler signal of [[tricuspid insufficiency]] using the modified Bernoulli equation: | * Right ventricular peak systolic pressure may be estimated from the Doppler signal of [[tricuspid insufficiency]] using the modified Bernoulli equation: | ||
* | ** Right ventricular peak systolic pressure = RAP + 4V<sup>2</sup> | ||
* | *** Where RAP equals the estimated right atrial pressure based upon examination of the jugular neck veins, V is the velocity of the [[tricuspid insufficiency]] jet by Doppler ultrasonography, and V<sup>2</sup> refers to V squared. A right ventricular peak systolic pressure above 30 mmHg is considered elevated. Mild elevation is 30 to 45 mmHg, moderate 45 to 60 mmHg, and severe is greater than 60 mmHg. | ||
* In the absence of [[pulmonary stenosis]] (which is rare), right ventricular systolic pressure is equal to the pulmonary artery systolic pressure. As a result, this equation is useful for estimating the presence and severity of [[pulmonary hypertension]]. When significant [[pulmonary artery hypertension]] (>45 to 50 mmHg) complicates [[Right ventricular myocardial infarction|right ventricular infarction]], the failing right ventricle may be unable to pump blood from the right heart into the left heart. In this setting, a positive inotropic agent such as [[dobutamine]] may be effective in augmenting forward flow while also decreasing [[pulmonary vascular resistance]] and right ventricular overload | * In the absence of [[pulmonary stenosis]] (which is rare), right ventricular systolic pressure is equal to the pulmonary artery systolic pressure. As a result, this equation is useful for estimating the presence and severity of [[pulmonary hypertension]]. When significant [[pulmonary artery hypertension]] (> 45 to 50 mmHg) complicates [[Right ventricular myocardial infarction|right ventricular infarction]], the failing right ventricle may be unable to pump blood from the right heart into the left heart. In this setting, a positive inotropic agent such as [[dobutamine]] may be effective in augmenting forward flow while also decreasing [[pulmonary vascular resistance]] and right ventricular overload. | ||
==References== | ==References== | ||
Revision as of 13:40, 20 September 2012
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Right ventricular myocardial infarction Microchapters |
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Differentiating Right ventricular myocardial infarction from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Echocardiography
- Echocardiography may be limited in right ventricular infarction by suboptimal views of the right ventricle. In addition, interpretation of right ventricular function may be affected by coexistent pulmonary disease (such as obstructive lung disease or pulmonary embolism).
- Despite these limitations, echocardiography is often a useful test that can be performed at the bedside when the diagnosis of right ventricular infarction is suspected. Right ventricular size, function, and the degree (if any) of tricuspid insufficiency can all be evaluated. [1] Useful information concerning left-sided structures and function can also be obtained. [2][3]
- Right ventricular peak systolic pressure may be estimated from the Doppler signal of tricuspid insufficiency using the modified Bernoulli equation:
- Right ventricular peak systolic pressure = RAP + 4V2
- Where RAP equals the estimated right atrial pressure based upon examination of the jugular neck veins, V is the velocity of the tricuspid insufficiency jet by Doppler ultrasonography, and V2 refers to V squared. A right ventricular peak systolic pressure above 30 mmHg is considered elevated. Mild elevation is 30 to 45 mmHg, moderate 45 to 60 mmHg, and severe is greater than 60 mmHg.
- Right ventricular peak systolic pressure = RAP + 4V2
- In the absence of pulmonary stenosis (which is rare), right ventricular systolic pressure is equal to the pulmonary artery systolic pressure. As a result, this equation is useful for estimating the presence and severity of pulmonary hypertension. When significant pulmonary artery hypertension (> 45 to 50 mmHg) complicates right ventricular infarction, the failing right ventricle may be unable to pump blood from the right heart into the left heart. In this setting, a positive inotropic agent such as dobutamine may be effective in augmenting forward flow while also decreasing pulmonary vascular resistance and right ventricular overload.
References
- ↑ Zehender, M, Kasper, W, Kauder, E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328:981. PMID 8450875
- ↑ Zehender, M, Kasper, W, Kauder, E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328:981. PMID 8450875
- ↑ Kahn, JK, Bernstein, M, Bengston, JR. Isolated right ventricular myocardial infarction. Ann Intern Med 1993; 118:708. PMID 8460858