Right Ventricular Infarction

Right ventricular (RV) ischemia occurs in a substantial proportion of patients with acute inferior myocardial infarction (MI), and may result in severe hemodynamic compromise. This defines a high-risk subset of patients with a mortality rate of 25% to 30%, as opposed to an overall mortality rate of approximately 6% patients with inferior MI without right ventricular infarction (RVI). Early recognition of RV ischemic dysfunction is of great importance in inferior MI with clinical evidence of low cardiac output, because the therapeutic approaches are very different from that for cardiogenic shock resulting predominantly from severe left ventricular (LV) failure. Management of RV ischemic dysfunction includes maintenance of RV preload with volume loading and maintenance of atrioventricular synchrony, inotropic support, and reduction of RV afterload in the setting of LV dysfunction. Reperfusion therapy should be initiated in patients with RV ischemic dysfunction. Though the RV appears to be relatively resistant to infarction and has a remarkable ability to recover even after prolonged occlusion, successful reperfusion of the right coronary artery and major RV branches rapidly improves RV ejection fraction and hemodynamic status, and decreases in-hospital mortality and morbidity.