Right ventricular myocardial infarction risk factors

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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

Risk Factors

  • The presence of right ventricular infarction adversely affects the early prognosis. One study, for example, evaluated 200 consecutive patients with acute inferior myocardial infarction. [1] Those with ST elevation in V4R had an almost eight-fold increase in in-hospital mortality (31 versus 6 percent) and morbidity when compared to those without changes in V4R.
  • Elderly patients who have right ventricular involvement with an inferior wall myocardial infarction are at a particularly high risk. In a study of 198 patients ≥ 75 years of age, right ventricular involvement was associated with an in-hospital mortality of 47 percent compared to a 10 percent mortality in the absence of right ventricular involvement. [2]
  • For patients who survive an acute right ventricular infarction, the prognosis is generally good. As an example, among 522 patients with an inferior wall infarction who were treated with a thrombolytic agent and hirudin or heparin in the HIT-4 study, 32 percent had right ventricular involvement and these patients had a higher 30 day mortality when compared to those without right ventricular involvement (5.9 versus 2.5 percent). [3] However, this was related to a larger infarct size rather than right ventricular involvement; right ventricular involvement was not an independent predictor of survival.
  • The right ventricle frequently recovers the majority of its function, probably due at least in part to decreased oxygen demand of the thin-walled right ventricle. [4] [5] These patients may, however, have a more frequent requirement for a permanent pacemaker. [6]

References

  1. 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
  2. Bueno, H, Lopez-Palop, R, Bermejo, J, et al. In-hospital outcome of elderly patients with acute inferior myocardial infarction and right ventricular involvement. Circulation 1997; 96:436. PMID 9788824
  3. 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
  4. Williams, JF. Right ventricular infarction. Clin Cardiol 1990; 13:309. PMID 2189611
  5. Cohn, JN. Right ventricular infarction revisited. Am J Cardiol 1979; 43:666. PMID 420117
  6. 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



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