Right ventricular myocardial infarction overview

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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

Acute myocardial infarction involving only the free wall of the right ventricle is a rare event. [1] More commonly, right ventricular infarction is associated with infarction of the inferior wall of the left ventricle, occurring in more than one-third of such cases,[2] [3] [4] [5] [6] [7] [8] [9] [10] even when a thrombolytic therapy is given. [11]

One study of 113 patients with a first acute inferior wall infarction reported that the presence of preinfarction angina within 72 hours of the infarction was associated with a reduction in the incidence of right ventricular infarction (odds ratio 0.2) and combined hypotension and shock (odds ratio 0.1). [12] This is possibly the result of ischemic preconditioning.

  • Ninety percent of right ventricular infarcts result from occlusion of the proximal right coronary artery, while another 5 to 10 percent arise after occlusion of the left anterior descending artery [13] [14] [15] [16]

Although more than one-third of cases are clinically silent [17], the presence of right ventricular infarction often has important implications for both management and prognosis.

References

  1. Anderson, HR, Falk, E, Nielsen, D. Right ventricular infarction: Frequency, size, and topography in coronary heart disease. J Am Coll Cardiol 1987; 10:1223. PMID 3680789
  2. Anderson, HR, Falk, E, Nielsen, D. Right ventricular infarction: Frequency, size, and topography in coronary heart disease. J Am Coll Cardiol 1987; 10:1223. PMID 3680789
  3. Isner, JM, Roberts, WC. Right ventricular infarction complicating left ventricular infarction secondary to coronary artery disease: frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. Am J Cardiol 1978; 42:885. PMID 153103
  4. Isner, JM. Right ventricular myocardial infarction. JAMA 1988; 259:712. PMID 3275819
  5. Williams, JF. Right ventricular infarction. Clin Cardiol 1990; 13:309. PMID 2189611
  6. Cabin, HS, Clubb, S, Wackers FJ, et al. Right ventricular myocardial infarction with anterior wall left ventricular infarction: an autopsy study. Am Heart J 1987; 113:16. PMID 3799430
  7. Kinch, JW, Ryan, TJ. Right ventricular infarction. N Engl J Med 1994; 330:1211. PMID 8139631
  8. Setaro, JF, Cabin, HS. Right ventricular infarction. Cardiol Clin 1992; 10:69. PMID 1739961
  9. Cohn, JN. Right ventricular infarction revisited. Am J Cardiol 1979; 43:666. PMID 420117
  10. Wackers, FJ, Lie, KI, Sokole, EB, et al. Prevalence of right ventricular involvement in inferior wall infarction associated with myocardial imaging with thallium-201 and technetium-99m pyrophosphate. Am J Cardiol 1978; 42:358. PMID 210648
  11. Zeymer, U, Neuhaus, K-L, Wegscheider, K, et al. Effects of thrombolytic therapy in acute inferior myocardial infarction with and without right ventricular involvement. J Am Coll Cardiol 1998; 32:876. PMID 9768705
  12. Shiraki, H, Yoshikawa, T, Anzai, T, et al. Association between preinfarction angina and a lower risk of right ventricular infarction. N Engl J Med 1998; 338:941. PMID 9521981
  13. Isner, JM, Roberts, WC. Right ventricular infarction complicating left ventricular infarction secondary to coronary artery disease: frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. Am J Cardiol 1978; 42:885.PMID 153103
  14. Isner, JM. Right ventricular myocardial infarction. JAMA 1988; 259:712. PMID 3275819
  15. Williams, JF. Right ventricular infarction. Clin Cardiol 1990; 13:309. PMID 2189611
  16. Cabin, HS, Clubb, S, Wackers FJ, et al. Right ventricular myocardial infarction with anterior wall left ventricular infarction: an autopsy study. Am Heart J 1987; 113:16. PMID 3799430
  17. Wackers, FJ, Lie, KI, Sokole, EB, et al. Prevalence of right ventricular involvement in inferior wall infarction associated with myocardial imaging with thallium-201 and technetium-99m pyrophosphate. Am J Cardiol 1978; 42:358. PMID 210648



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