Search
right ventricular myocardial infarction (MI)
Pathology:
- associated with inferior wall MI with extension to involve posterior wall & right ventricle
Clinical manifestations:
- evidence of right heart failure
a) jugular venous distension (elevated central venous pressure)
b) hypotension
c) clear lung fields
Special laboratory:
- electrocardiogram:
- right precordial leads:
a) > 1 mm ST segment elevation in V4R
b) 88% sensitivity, 78% specificity for RV-MI
* ST segment elevation in leads II, III & aVF indicate inferior wall MI
- all patients with inferior wall MI should have right-sided ECG
- ST segment elevation in right-sided lead V4 is the most sensitive indicator for right ventricular MI
- ST segment elevation in lead V1 (less sensitive)
Radiology:
- echocardiogram: (if diagnosis is uncertain)
1) right ventricular dilation
2) free wall hypokinesis
Management:
- push normal saline (several liters) to restore right ventricular contractility & left ventricular preload
- patients with right ventricular MI are preload-dependent
- avoid reduction in preload
a) nitrates
b) diuretics
c) reduction in preload predisposes to atrial fibrillation
- avoid pressors until volume expansion produces pulmonary edema [1]
Related
right ventricle (RV)
right ventricular failure; right heart failure
General
myocardial infarction (MI); heart attack
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 19.
American College of Physicians, Philadelphia 1998, 2022
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022
- Kinch JW, Ryan TJ
Right Ventricular Infarction
N Engl J Med 1994. 330(17):1211
PMID: 8139631
https://www.nejm.org/doi/pdf/10.1056/NEJM199404283301707
- Namana V, Gupta SS, Abbasi AA, Raheja H, Shani J, Hollander G.
Right Ventricular Infarction
Cardiovasc Revasc Med. 2018 Jan;19(1 Pt A):43-50.
PMID: 28822687 Review.