Right ventricular infarction

Right ventricular infarction Right ventricular infarction can be associated with inferior wall infarction. It is due to occlusion of the right ventricular branches of the right coronary artery. The actual prevalence of right ventricular infarction may be underestimated because right sided chest leads are not part of routine 12 lead ECG. In a study which included right sided chest leads V3R, V4R, V5R and V6R, ST elevation of 1 mm or more in any of these leads was found to be a reliable sign of right ventricular involvement. It was a study of 67 patients who underwent serial electrocardiograms and 99mtechnetium pyrophosphate scintigraphy and a dynamic flow study to document right ventricular infarction [1]. They noted that ST elevation of 1 mm or more in V4R had the greatest sensitivity of 93% and predictive accuracy (93%) for right ventricular myocardial infarction. Of special interest was the  observation that ST segment elevation in right precordial leads was short lived, disappearing in 10 hours in half of the patients with right ventricular infarction. So recording right chest leads within 10 hours of onset of chest pain is important in picking up right ventricular infarction. Right ventricular infarction decreases its output and consequently the left ventricular preload leading to a decrease in cardiac output. Profound hypotension can be noted in some cases. The ischemic right ventricle is stiff and volume dependent [2], thereby explaining the role of fluid resuscita...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology Source Type: blogs