Right ventricular myocardial infarction history and symptoms
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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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Diagnosis |
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Treatment |
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Pharmacological Reperfusion |
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Mechanical Reperfusion |
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Antithrombin Therapy |
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Antiplatelet Agents |
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Other Initial Therapy |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Diagnosis
- Because the right ventricle has a remarkable tendency to recover function rapidly, diagnostic tests are most reliable when performed soon after presentation. Clinical suspicion and a careful physical examination demonstrating the signs are the first step.
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Places of chest leads during EKG recording for suspected RVMI.
In general, requirements of diagnosing a right ventricular myocardial infarction as follow:
- Right-sided ST segment elevation of > 1 mm (leads V3R through V6R)
- Right ventricular asynergy as demonstrated by echocardiography or cardiac nuclear imaging
- Mean right arterial pressure of ≥ 10 mm Hg or a < 5 mm Hg difference from mean pulmonary capillary wedge pressure (equivalent to left atrial pressure)
- Non-compliant right atrial pressure waveform pattern (steep and deep x and y descents)
History and Symptoms
- Ischemia or infarction of the right ventricle results in decreased right ventricular compliance, reduced filling, and diminished right-sided stroke volume with concomitant right venticular dilation and alteration in septal curvature [1] These hemodynamic and geometric changes lead to decreased left ventricular filling and contractile function with a concomitant fall in cardiac output [2] [3] [4] [5] [6] [7]. The net effect is that left-sided filling pressures may be below normal despite clinical signs of high pressure on the right side. This disparity has important implications for therapy (see below).
- Patients with hemodynamically significant right ventricular infarction typically present with hypotension, jugular vein distention, and occasionally shock, all in the presence of clear lung fields. Valvular insufficiency can also occur, leading to tricuspid regurgitation. These findings are in contrast to the frequent pulmonary congestion, third or fourth heart sounds, and mitral regurgitation with left ventricular infarcts.
References
- ↑ Brookes, C, Ravn, H, White, P, et al. Acute right ventricular dilatation in response to ischemia significantly impairs left ventricular systolic performance. Circulation 1999; 100:761. PMID 10449700.
- ↑ Williams, JF. Right ventricular infarction. Clin Cardiol 1990; 13:309. PMID 2189611
- ↑ Kinch, JW, Ryan, TJ. Right ventricular infarction. N Engl J Med 1994; 330:1211. PMID 8139631
- ↑ Setaro, JF, Cabin, HS. Right ventricular infarction. Cardiol Clin 1992; 10:69. PMID 1739961
- ↑ Cohn, JN. Right ventricular infarction revisited. Am J Cardiol 1979; 43:666. PMID 420117
- ↑ 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
- ↑ 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