Right ventricular myocardial infarction other imaging findings

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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]

Overview

Other Imaging Findings

Radionuclide ventriculography and technetium-99m-pyrophosphate scanning
  • These techniques have acceptable sensitivities and specificities for making a diagnosis of right ventricular infarction. [1] [2] [3] [4] Radionuclide angiography can detect wall motion abnormalities and hypoperfusion in the affected right ventricle. It can also be used to quantitate both left and right ventricular ejection fractions. Technetium scanning, on the other hand, is particularly useful for late diagnosis, as it shows areas of necrotic or dying myocardium.
  • However, both methods are cumbersome and time consuming. They are also frequently difficult to perform at the bedside, particularly when the patient is unstable in the intensive care unit and nuclear cardiology equipment is not readily portable. Thus, these tests are best performed later in the course to further quantify the degree of right ventricular infarction and dysfunction.

References

  1. Kinch, JW, Ryan, TJ. Right ventricular infarction. N Engl J Med 1994; 330:1211. PMID 8139631
  2. Cohn, JN. Right ventricular infarction revisited. Am J Cardiol 1979; 43:666. PMID 420117
  3. Zehender, M, Kasper, W, Kauder, E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328:981. PMID 8450875
  4. Kahn, JK, Bernstein, M, Bengston, JR. Isolated right ventricular myocardial infarction. Ann Intern Med 1993; 118:708. PMID 8460858



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