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
Since 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).
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