Caracterización clínico epidemiológica del infarto agudo del miocardio inferior extendido a ventrículo derecho en Ciego de Ávila / Clinical epidemiological characterization of the lower face acute myocardial infarction extended to the right ventricle in Ciego de Ávila

RESUMEN Fundamento: La cardiopatía isquémica es uno de los principales problemas de salud tanto en países desarrollados como en países en vías de desarrollo, una de las enfermedades que prevalece en el mundo y con mayor mortalidad. Cada año, millones de personas son ingresadas en los servicios de urgencias por motivos de consulta relacionados con el sistema cardiovascular; de estos ingresos, una gran proporción corresponde al infarto agudo de miocardio. Objetivo: Describir las características clínicas epidemiológicas de los pacientes con infarto agudo de miocardio inferior con extensión al ventrículo derecho. Metodología: Se realizó un estudio observacional, descriptivo transversal, en 46 pacientes ingresados en la Sala de Cardiología en el Hospital Provincial General Docente "Dr. Antonio Luaces Iraola", provincia Ciego de Ávila, período julio de 2016 a junio de 2019 y que cumplieron con los criterios establecidos en el estudio. Resultados: En la mayoría de los pacientes los factores de riesgo que predominaron fueron la hipertensión arterial y la diabetes mellitus, en el grupo de edades entre 60 y 69 años del sexo masculino. La forma de presentación más frecuente fue el dolor precordial y la complicación el bloqueo auriculoventricular. Un porcentaje alto de los pacientes recibió terapia trombolítica. Conclusiones: Predominaron los pacientes en edades comprendidas entre 60 y 69 años del sexo masculino y con antecedentes de hipertensión arterial y diabetes mellitus. La complicación más frecuente fue el bloqueo auriculoventricular y su forma de presentación el dolor precordial. Un alto número de pacientes recibieron tratamiento trombolítico.

ABSTRACT Background: Ischemic heart disease is one of the main health problems in both developed and developing countries, one of the most prevalent diseases in the world and with higher mortality. Every year, millions of people are admitted to the emergency services for consulting reasons related to the cardiovascular system; of these admissions, a large proportion corresponds to acute myocardial infarction. Objective: To describe the epidemiological clinical characteristics of patients with lower acute myocardial infarction with extension to the right ventricle. Methodology: An observational, descriptive cross-sectional study was carried out in 46 hospitalized patients in the Cardiology Room at the General Provincial Teaching Hospital "Dr. Antonio Luaces Iraola", Ciego de Ávila province, from July 2016 to June 2019 and who had the criteria established in the study. Results: In the majority of patients, the predominant risk factors were hypertension and diabetes mellitus, in the age group between 60 and 69 years of male sex. The most frequent form of presentation was precordial pain and the complication was atrioventricular block. A high percentage of the patients received thrombolytic therapy. Conclusions: Prevailed patients between 60 and 69 years of age, male and with a history of high blood pressure and diabetes mellitus. The most frequent complication was ventricular atrium block and its presentation was precordial pain. A high number of patients received thrombolytic treatment.

Isolated right ventricle infarction

We described two patients who were successfully resuscitated from out-of-hospital cardiac arrest. Their ECGs showed ST elevations in V1 and aVR, as well as diffuse ST depression. Their ST elevation in V1 was noted to be greater than in aVR. While one patient was found to have an occlusion of the right ventricular (RV) branch of the right coronary artery, the other was found to have an occlusion of a proximal non-dominant right coronary artery supplying the RV branch. Successful primary percutaneous coronary intervention was performed for each patient with angioplasty and implantation of a drug-eluting stent. Both patients made good physical and neurological recovery.

Early Risk Assessment In Right Ventricular Infarction By TIMI Risk Score.

Background: Inferior myocardial infarction complicated by right ventricular infarction is associated with a greater risk of in-hospital mortality and cardiovascular related complications. Early risk stratification of patients with right ventricular infarction is crucial for appropriate management and reduction of adverse cardiac events. The development of TIMI risk score has provided a useful tool to quickly and easily stratify patients with right ventricular infarction. We conducted this study to evaluate the prognostic value of TIMI Risk Score analysis in patients with right ventricular infarction. Methods: This observational study was conducted in the department of Cardiology in NICVD, Dhaka, from July 2006 to June 2008. Considering inclusion and exclusion criteria, a total of 60 patients with right ventricular infarction were evaluated. All the patients were evaluated clinically and ECG was done after admission. Patients were categorized into two groups by TIMI risk scoring. Patients with low TIMI risk score(0-3) were in Group-I and patients with high TIMI risk score(4- 14) were in Group-II. Results: The study revealed no statistically significant difference among the patients of two groups (p>0.05) in relation to sex, weight, risk factors and presenting complaints. Analysis revealed statistically significant difference among the patients of two groups (p<0.05) in relation to age, duration of chest pain, clinical parameters, Killip class of heart failure and LVEF. Regarding inhospital outcome, 51.7% patients developed complications during the study period and all the complications were more in group II patients with high TIMI risk score(4-14). Death (18.3%) was the most common complication followed by cardiogenic shock (15.0%), complete heart block(6.6%),cardiac arrest(6.6%),VT(3.3%)and 2nd degree heart block(1.6%). Conclusion: This study indicates that on admission - TIMI risk score analysis can identify patients with right ventricular infarction at higher risk for in-hospital mortality and morbidity.

Clinical Outcome and Echocardiographic Evaluation of Inferior Myocardial Infarction with Right Ventricular Involvement.

Background : Acute right ventricular myocardial infarction complicates inferior wall myocardial infarction with an incidence of 14-84%. ECG is the cornerstone in initial diagnosis as it is cost effective and done easily. Echocardiographic analysis of the right ventricular involvement can shed light on the severity of the disease. Hence we aimed to study right ventricular infarction in acute inferior wall myocardial infarction using right precordial lead as well as echocardiography. Methods: Present study is based on the analysis of 100 patients admitted to Coronary care unit of the National Institute of Cardiovascular Diseases & Hospital during July 2010 to June 2011, with acute inferior wall myocardial infarction. 12 lead ECG with thorough physical examination was done along with right precordial mapping. ST ³ 1mm in V4R was initial diagnostic of right ventricular involvement followed by echocardiographic assessment of RV and LV within 24 hours. Results: A total of 50 patients showed right ventricular involvement with V4R being the sensitive lead. Echocardiography showed mean RVEF of patients with 29.5 % ± 9.5 in comparison of 44.9%±12.2 without right ventricular involvement. Right ventricular involvement presented with bradycardia (40%) and hypotension, 80% Kussmaul’s sign, 14% with complete heart block. Mortality in right ventricular involvement was 6 times higher than without right ventricular involvement (12 %). Conclusion: Clinical signs and symptomatology are not fully diagnostic of RVI in inferior wall acute MI. ECG can diagnose (using right precordial mapping) this condition very early. Echocardiography help to assess the right ventricular function high-risk groups for aggressive management like primary PCI. Early diagnosis will help in careful monitoring and management of such cases.

Impact of Right Ventricular Myocardial Involvement on Mortality and Morbidity during Percutaneous Coronary Intervention

PURPOSE: Right ventricular (RV) involvement during acute inferior myocardial infarction (MI) is associated with increased early mortality and morbidity. However, little is known concerning mortality and morbidity after right ventricular myocardial infarction (RVMI) during percutaneous coronary intervention (PCI). METHODS: This retrospective study was performed in a university training hospital. Patients with inferior MI (n=94) who presented to the emergency department between November 2005 and October 2007 were included. We examined the incidence of death, mechanical complications and electrical complications in patients with (n=29) and without (n=65) RV myocardial involvement. RV involvement was assessed by ST-Segment elevation > or =0.1 mV in lead V4R. PCI was performed in all patients. RESULTS: In-hospital mortality was 3.4% in RVMI compared with 3.1% in non-RVMI (p=1.00). There was no significant difference in the incidence of mechanical complications and electrical complications between patients with and without RVMI. CONCLUSION: Patients who have inferior MI with RV myocardial involvement are not at increased risk of death, mechanical complications and electrical complications.

Right-to-Left Shunting through a Patent Foramen Ovale as a Cause of Hypoxemia in a Patient with Acute Right Ventricular Infarction Diagnosed by Contrast Echocardiography

Right ventricular (RV) infarction is a well-recognized complication of acute inferior myocardial infarction. Rightto-Left shunt through a patent foramen ovale (PFO) is an unusual complication of acute RV myocardial infarction that can result in the development of severe hypoxemia. However, the diagnosis may not be easy without high index of suspicion and echocardiography combined with an echocardiographic contrast (agitated saline) is useful diagnostic imaging modality in this regard. We report a case of acute inferior myocardial infarction and RV infarction associated with unexplained hypoxemia. Contrast echocardiography detected a significant right to left shunt through patent foramen ovale, which considered as a cause of hypoxemia in this patient.

Comportamento hemodinâmico do ventrículo direito no infarto agudo de parede inferior: comparaçäo entre pacientes que evoleum com e sem choque / Behavior of the Right Ventricle in Acute Inferior Wall Myocardial Infarction. Comparison Between Patients With and With out Cardiogenic Shock

PURPOSE--To evaluate the hemodynamic profile of patients (pts) with acute inferior wall myocardial infarction (AMI) and dysfunction of right ventricle (RV). METHODS--Ninety nine consecutive pts (aged 56.6 +/- 3.4 years), 47 men, with inferior AMI and RV dysfunction were studied. RV infarction was diagnosed based on ST segment elevation (> lmm) in precordial V4R lead and RV abnormalities found in echocardiography. All pts were undergone to bedside hemodynamic studies, by measuring mean right atrial (RAP), pulmonary artery (PAP), wedge pulmonary (PWP), and radial artery (AP) pressures and cardiac output (CO). Cardiac index (CI), pulmonary (PAR) and systemic arterial resistance (SAR) were calculated in dynes x sec x cm-5. Left ventricle (LV) ejection fraction (EF) and RV-EF were obtained by contrast ventriculography. Cardiogenic shock was diagnosed based on AP < or = 70 mmHg, RAP > or = 7 mmHg, PWP < or = 20mm Hg, CI < or = 1.8l/min/m2 and oliguria. Pts were then subdivided in 2 groups: with cardiogenic shock (group A, n = 41) with a mean age of 55.4 +/- 2.1 and without shock (group B, n = 58) with a mean age of 57.2 +/- 1.7. RESULTS--No significant differences between groups regarding RAP, PWP, AP and LVEF were observed, but compared to group B, group A had lower CI (1.3 +/- 0.3 vs 2.6 +/- 0.5 l/min/m2, p < 0.05), higher SVR (2314 +/- 252 vs 1324 +/- 324 dynes.sec.cm-5, p < 0.01), and lower RVEF (0.27 +/- 0.08 vs 0.41 +/- 0.11//, p < 0.05). CONCLUSION--Pts with inferior AMI and RV dysfunction, cardiogenic shock depends on of RV failure and is independent of a preserved LV function