Right ventricular myocardial infarction echocardiography or ultrasound

Right ventricular myocardial infarction Microchapters
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Overview
Pathophysiology
Pathophysiology of Reperfusion
Gross Pathology
Histopathology
Causes
Differentiating Right ventricular myocardial infarction from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Electrocardiogram
Chest X Ray
Echocardiography or Ultrasound
Coronary Angiography
Other Imaging Findings
Treatment
Initial Care
Pharmacological Reperfusion
Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)
Fibrinolysis
Mechanical Reperfusion
The Importance of Reducing Door-to-Balloon Times
Primary PCI
Adjunctive and Rescue PCI
Rescue PCI
Facilitated PCI
Adjunctive PCI
CABG
Management of Patients Who Were Not Reperfused
Assessing Success of Reperfusion
Antithrombin Therapy
Antithrombin Therapy
Unfractionated Heparin
Low Molecular Weight Heparinoid Therapy
Direct Thrombin Inhibitor Therapy
Factor Xa Inhibition
DVT Prophylaxis
Long Term Anticoagulation
Antiplatelet Agents
Aspirin
Thienopyridine Therapy
Glycoprotein IIbIIIa Inhibition
Other Initial Therapy
Inhibition of the Renin-Angiotensin-Aldosterone System
Magnesium Therapy
Glucose Control
Calcium Channel Blocker Therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Echocardiography

• Echocardiography may be limited in right ventricular infarction by suboptimal views of the right ventricle. In addition, interpretation of right ventricular function may be affected by coexistent pulmonary disease (such as obstructive lung disease or pulmonary embolism).
• Despite these limitations, echocardiography is often a useful test that can be performed at the bedside when the diagnosis of right ventricular infarction is suspected. Right ventricular size, function, and the degree (if any) of tricuspid insufficiency can all be evaluated. Useful information concerning left-sided structures and function can also be obtained.
• Right ventricular peak systolic pressure may be estimated from the Doppler signal of tricuspid insufficiency using the modified Bernoulli equation:
  • Right ventricular peak systolic pressure = RAP + 4V²
    • Where RAP equals the estimated right atrial pressure based upon examination of the jugular neck veins, V is the velocity of the tricuspid insufficiency jet by Doppler ultrasonography, and V² refers to V squared. A right ventricular peak systolic pressure above 30 mmHg is considered elevated. Mild elevation is 30 to 45 mmHg, moderate 45 to 60 mmHg, and severe is greater than 60 mmHg.
• In the absence of pulmonary stenosis (which is rare), right ventricular systolic pressure is equal to the pulmonary artery systolic pressure. As a result, this equation is useful for estimating the presence and severity of pulmonary hypertension. When significant pulmonary artery hypertension (> 45 to 50 mmHg) complicates right ventricular infarction, the failing right ventricle may be unable to pump blood from the right heart into the left heart. In this setting, a positive inotropic agent such as dobutamine may be effective in augmenting forward flow while also decreasing pulmonary vascular resistance and right ventricular overload.