Open AccessRight ventricular infarction—diagnosis and treatment
Author(s) -
Haji Showkat A.,
Movahed Assad
Publication year - 2000
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960230721
Subject(s) - medicine , cardiology , preload , shock (circulatory) , venous return curve , myocardial infarction , radionuclide ventriculography , infarction , hemodynamics , heart failure , ejection fraction
Right ventricular infarction (RVI) as assessed by various diagnostic methods accompanies inferior‐posterior wall myocardial infarction (MI) in 30 to 50% of patients. Recognition of the syndrome of RVI is important as it defines a significant clinical entity, which is associated with considerable immediate morbidity and mortality and has a well—delineated set of priorities for its management. Patients may clinically present with hypotension, elevated jugular venous pulse (JVP), and occasionally shock, all in the presence of clear lung fields. The ST—segment elevation of ⩾ 0.1 mV in the right precordial leads V 4 R is a readily available electrocardiographic sign used for diagnosis of RVI. Other diagnostic approaches for assessing RVI include echocardiography, radionuclide ventriculography, technetium pyrophosphate scanning, and hemodynamic measurements. The proper management of RVI includes volume loading to maintain adequate right ventricular preload, ionotropic support, and maintenance of atrioventricular synchrony. Reperfusion therapy should be initiated at the earliest signs of right ventricular dysfunction. Finally, complete recovery over a period of weeks to months is a rule in a majority of patients, suggesting right ventricular “stunning” rather than irreversible necrosis has occurred.