Right ventricular myocardial infarction diagnostic criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

This diagnosis of right ventricular myocardial infarction should be considered in patients with the clinical triad of hypotension, clear lung fields, and jugular venous distention. The diagnosis can be made using a right-sided electrocardiogram, on which ST-segment elevation in leads V3R and V4R is found.

Diagnostic Studies

• Clinical triad of hypotension, clear lung fields, and jugular venous distention.
• Electrocardiogram

• • In addition to evidence of an acute inferior or inferoposterior myocardial infarction, the ECG may demonstrate > or =1 mm of doming ST elevation in the right sided precordial leads V4R to V6R.
  • Right sided ST elevation, particularly in V4R, is indicative of acute right ventricular injury and correlates closely with occlusion of the proximal right coronary artery.

• • In one report of patients with acute inferior infarction, for example, ST elevation in V4R had 88 percent sensitivity and 78 percent specificity for concurrent right ventricular infarction

• • Pulmonary embolism, pericarditis, and |anteroseptal myocardial infarction also cause elevation of the ST segment in the right-sided precordial leads. As a result, an electrocardiographic diagnosis of right ventricular infarction cannot be made when one of these conditions is present

• The right atrial pressure exceeds 10 mmHg and the ratio of right atrial pressure to pulmonary capillary wedge pressure exceeds 0.8 (normal mean value less than 0.6) .

• However, these findings may not be present in patients with only minimal right ventricular dysfunction or in those with intravascular volume depletion. In the latter setting, a volume challenge may unmask the signs of right ventricular infarction