Clinical profiling of right ventricular infarction in patients with acute inferior wall myocardial infarction

Background: Incidence of Right Ventricular Myocardial Infarction (RVMI) associated with Inferior Wall Myocardial Infarction (IWMI) is reported to be quite high (30%-50%). To diagnose coexisting RVMI is important, since its early recognition and proper treatment reduces overall morbidity and mortality in IWMI. Author assessed the incidence and clinically profiled patients with right ventricular infarction in acute inferior wall myocardial infarction and analysed the effects of RVMI on clinical outcome of IWMI.Methods: A total of 150 patients of IWMI were evaluated in the present hospital based prospective observational study over duration of two years. They were evaluated for coronary risk factors like diabetes mellitus, hypertension, smoking, obesity, alcohol and dyslipidemia. Twelve-lead ECG, cardiac enzyme assay and echocardiography were undertaken in all the participants.Results: Of the total 150 patients, 45 (30%) patients had right ventricular myocardial infarction (RVMI). Complications were significantly lower in patients with isolated IWMI as compared to patients with IWMI and associated RVMI except pulmonary edema (p<0.05). Of the total 22 (14.67%) deaths in the present study, 18 (12%) had associated RVMI and 4 (2.66%) isolated IWMI, the difference being statistically significant.Conclusions: Involvement of right ventricle increases rate of complications as well as the mortality rate in patients with inferior wall myocardial infarction.

A case of resolution of inferior wall myocardial infarction and varying degrees of atrioventricular block: a case report.

Inferior wall myocardial infarction (IWMI) complicating with high degree atrioventricular (AV) block had been a subject of discussion for a long time. Also the transient nature of these AV blocks in the presence of IWMI is well known to us. However our case presented with IWMI with right ventricular MI (RVMI) and in complete heart block and subsequently post thrombolysis developed varying degrees of AV block and reverted back to sinus rhythm. We found it as an incidence not much reported and thus reporting the case herewith.

Haloperidol Induced Neurolept Malignant Syndrome Complicated by Right Ventricular Myocardial Infarction.

A fatal case of right ventricular myocardial infarction in the absence of risk factors, concurrent with haloperidol induced neuroleptic malignant syndrome, is presented; suggesting the existence of a causal relation between the two. Possible pathophysiological mechanisms have been discussed

Right ventricular myocardial infarction: echocardiographic evidence among patients with inferior wall myocardial infarction.

Right ventricular myocardial infarction (RVMI) predominantly a complication of inferior wall myocardial infarction is a distinct clinical entity in which major hemodynamic disturbance may occur. Bedside hemodynamic measurement, electrocardiography, gated blood pool radionuclide angiography and echocardiography are used to identify right ventricular involvement in setting of inferior wall infarction. RVMI as assessed by various diagnostic methods accompanies 30 to 50% of inferior wall infarction. We studied 37 consecutive patients of acute inferior wall infarction (by non invasive method) to determine echocardiographic evidence of RVMI and compared its sensitivity to electrocardiography and clinical criteria. On echocardiography 12 out of 37 patients (32%) had right ventricular involvement. Kussmaul’s signs was present in 27% of the patients and it had sensitivity of 50%, specificity of 88% and predictive accuracy of 70%. Right sided precordial leads (V3R – V4R) on electrocardiography showed evidence of RVMI in 30% of patients with sensitivity, specificity and predictive accuracy of 67%, 88% and 73% respectively. Echocardiographic features included enlargement of right ventricle and hypokinesia or akinesia of right ventricular wall. Right ventricular dilatation and dysfunction is gained from relative right and left ventricular dimension on echocardiography. It is more sensitive and specific than clinical signs and ECG.

Effects of Enalapril on hemodynamic indexes in cardiac shock dogs induced by acute right ventricular myocardial infarction / 中华急诊医学杂志

Objective To study the therapeutic effects of Enalapril on hemodynamic indexes in cardiac shock dogs induced by acute right ventricular myocardial infarction(RVMI).Methods Models of RVMI accompanied with cardiac shock were induced by ligating coronary artery.Dogs were randomly divided into three groups:control group,fluid replacement group and Enalapril group.The hemodynamie indexes including mean arterial pressure(MAP),cardiac output (CO),right atrial pressure(RAP)and right ventrieular systolic pressure(RVSP)were measured before and immediately after RVMI model establishment,and 1 hour and 1 week after the treatment.The therapeutic effects were evaluated. Results After rapid fluid replacement treatment,RAP became higher and the hemodynamics deteriorated.After Enalapril treatment,RAP decreased and CO increased.Conclusion When RVMI in large area occurs,fluid replacement would further deteriorate the heart function of left and right ventricles when RAP≥13 mmHg,and Enulapril fluid replacement would reduce the right ventricle load and improve shock.