[Infarction of the right ventricle].
Anatomical studies have confirmed that isolated right ventricular and anterior biventricular infarcts are rare. However, RV extension is found in 36 to 50 per cent of cases of postero-inferior infarcts, which confirms the findings of invasive and non-invasive investigations which detect acute RV dysfunction with the same frequency after this type of infarct. It is difficult to create right ventricular infarction experimentally because of the relative protection against ischaemia of the RV. In man, this condition almost always implies an associated thrombosis of the proximal right coronary artery and significant stenosis of the IVA, which justifies the broad indications for coronary angiography. The two major haemodynamic consequences of right ventricular infarction are due to original pathophysiological mechanisms: the adiastole seems to be due to a limitation of RV dilatation by the pericardium, the reduced output is due to faulty LV filling as a result of RV systolic dysfunction and associated factors such as the absence of efficient and synchronous atrial systole secondary to AVB (60%) or to acute right atrial paralysis. The choice of treatment is based on these pathophysiological data. The diagnosis of infarction of the RV is straightforward, often suggested on clinical examination (RVI syndrome: reduced output in 45% of cases) and the surface E.C.G. (ST-T depression 1 mm in V3R-V4R-V5R). The diagnosis is confirmed by more sophisticated investigations which can evaluate the degree of systolic dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)
D004452:Echocardiography; D006321:Heart / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D011877:Radionuclide Imaging
Les infarctus du ventricule droit.