9 November 2010

Right Ventricular Infarction


Right Ventricular Infarction Facts:
  • Present in 30% of inferior AMIs.
  • Isolated RV infarction is rare.
  • Suggested by ST segment elevation >1 mm in V4R.
  • Adverse prognostic indicator.
  • Reduced left sided filling pressures associated with systemic hypotension.
Right Ventricular Infarction Treatment:
  • If patient is hypotensive - may require aggressive fluid resuscitation to maintain BP.
  • RV end-diastolic pressure of 10-15 mm Hg has been associated with higher outputs than pressures lower or higher than this.[1]
  • Inotropic therapy is indicated for RV failure when cardiogenic shock persists following optimization of RV end-diastolic pressure.[2]
  • Persisting hypotension may warrant haemodynamic monitoring with a pulmonary artery catheter.
  • Care must be taken passing a balloon catheter or pacing wire because of the increased risk of right ventricular perforation.
  • Some evidence for the use of inhaled nitric oxide.[3]
  • Obtaining early reperfusion - if patient presents within 6 hours of onset of inferior wall myocardial infarction with RV involvement there is a definite early survival benefit from thrombolytic therapy or coronary angioplasty.[4,5]
References:
  • 1] - Claudia Dima et al. Right Ventricular Infarction (emedicine.medscape.com)
  • 2] - Reynolds HR, Hochman JS. Cardiogenic shock: current concepts and improving outcomes. Circulation. Feb 5 2008;117(5):686-97.
  • 3] - Inglessis I, Shin JT, Lepore JJ, Palacios IF, Zapol WM, Bloch KD, et al. Hemodynamic effects of inhaled nitric oxide in right ventricular myocardial infarction and cardiogenic shock. J Am Coll Cardiol. Aug 18 2004;44(4):793-8.
  • 4] -Vesterby A, Steen M. Isolated right ventricular myocardial infarction. A case report. Acta Med Scand. 1984;216(2):233-5.
  • 5] - Yoshino H, Udagawa H, Shimizu H. ST-segment elevation in right precordial leads implies depressed right ventricular function after acute inferior myocardial infarction. Am Heart J. Apr 1998;135(4):689-95.

Image: Right Ventricular Infarction (ECG)
Image Source: by Popfossa on flickr (cc)
Tags: AMI - Hypotension - Inferior MI - Nitric Oxide - Right Ventricular Infarction - RVEDP - V4R
Posted by Medicalchemy
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