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
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