Right ventricular myocardial infarction
- Thomas Levin, MD
Thomas Levin, MD
- Illinois Heart and Vascular
- Chicago, Illinois
- James A Goldstein, MD
James A Goldstein, MD
- Professor of Medicine
- Oakland University William Beaumont Hospital School of Medicine
- Section Editors
- Freek Verheugt, MD, FACC, FESC
Freek Verheugt, MD, FACC, FESC
- Section Editor — Coronary Heart Disease
- Onze Lieve Vrouwe Gasthuis, Netherlands
- Donald Cutlip, MD
Donald Cutlip, MD
- Section Editor — Interventional Cardiology
- Professor of Medicine
- Harvard Medical School
- Beth Israel Deaconess Medical Center
Acute myocardial infarction (MI) involving only the right ventricle is an uncommon event. More often, right ventricular MI (RVMI) is associated with acute ST-elevation myocardial infarction of the inferior wall of the left ventricle, and occurs in 30 to 50 percent of such cases [1-6].
RVMI is associated with higher in-hospital morbidity and mortality compared to patients with a similar infarction territory in the left ventricle but that does not involve the right ventricle. Poor outcome is usually related to profound hemodynamic and electrical complications, which occur in approximately 50 percent of affected individuals [1-9]. However, long-term prognosis is generally good for those who survive the event.
This topic will discuss the diagnosis and management of patients with RVMI. The general approach to patients with MI is found elsewhere. (See "Overview of the acute management of unstable angina and non-ST elevation myocardial infarction" and "Overview of the acute management of ST elevation myocardial infarction" and "Overview of the non-acute management of ST elevation myocardial infarction" and "Overview of the non-acute management of unstable angina and non-ST elevation myocardial infarction".)
Definitions — The following terms that are used in this topic are defined as follows:
●Stroke volume is the amount of blood pumped with each beat. It is influenced by preload, afterload, and contractility. (See "Pathophysiology of heart failure: Left ventricular pressure-volume and other hemodynamic relationships", section on 'Normal left ventricular pressure-volume relationship'.)
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- BASIC CONCEPTS
- Right ventricular infarction versus ischemia
- Site of the culprit lesion
- Hemodynamic consequences
- Electrical consequences
- CLINICAL PRESENTATION
- History and physical examination
- Electrocardiographic features
- Hemodynamic monitoring
- Other imaging studies
- DIFFERENTIAL DIAGNOSIS
- Optimization of right ventricular preload
- Optimization of right ventricular afterload
- Optimization of heart rate and AV synchrony
- Inotropic drugs
- Coronary reperfusion
- Mechanical assist devices
- Antiischemic drug therapy
- Recommendations of others
- Early prognosis
- Long-term prognosis
- SUMMARY AND RECOMMENDATIONS