right ventricular myocardial infarction (MI)
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Pathology
- associated with inferior wall MI with extension to involve posterior wall & right ventricle
Clinical manifestations
- evidence of right heart failure
- jugular venous distention (elevated central venous pressure)
- hypotension
- clear lung fields
Diagnostic procedures
- electrocardiogram:
- right precordial leads:
- > 1 mm ST segment elevation in V4R
- 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)
- right ventricular dilation
- 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
- nitrates
- diuretics
- reduction in preload predisposes to atrial fibrillation
- avoid pressors until volume expansion produces pulmonary edema[1]
More general terms
Additional terms
References
- ↑ 1.0 1.1 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/28822687 Review.