title: Right ventricular myocardial infarction: From pathophysiology to prognosis.
abstract: Right ventricle myocardial infarctions (RVMIs) accompany inferior wall ischemia in up to one-half of cases. The clinical sequelae of RVMIs vary from no hemodynamic compromise to severe hypotension and cardiogenic shock. Diagnosis is based on physical examination, electrocardiography, echocardiography and coronary angiography. Because the standard 12-lead electrocardiogram is insufficient for the assessment of RV involvement, right-sided precordial leads should always be included. Adequate fluid administration in combination with positive inotropic agents and early coronary reperfusion are crucial components of treatment, while diuretics and nitrates should be avoided. Intra-aortic balloon counterpulsation and right ventricle assist devices may be used with success in RVMIs associated with medically refractory heart failure. Right ventricular involvement appears to be an independent prognostic factor that dramatically increases in-hospital mortality, due, in part, to a significantly higher risk of hemodynamically compromising arrhythmias. Thus, using right-sided precordial leads and early RVMI identification to trigger an appropriately aggressive treatment protocol may improve patients' prognosis.
authors.affiliation: Department of Internal Medicine and Cardiology, Masaryk University and University Hospital Brno, Brno, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Ondrus
authors.forename: Jan
authors.initials: J
authors.lastname: Kanovsky
authors.forename: Tomas
authors.initials: T
authors.lastname: Novotny
authors.forename: Irena
authors.initials: I
authors.lastname: Andrsova
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.forename: Petr
authors.initials: P
authors.lastname: Kala
keywords: Arrhythmias; Revascularization; Right ventricular myocardial infarction; Treatment