[Infarct of the right half of the heart]

Isolated right ventricular infarction is not rare, as it is generally believed. As a rule, right ventricular infarction occurs in association with left ventricular infarction. Diagnosis of right ventricular infarction can not be made clinically alone. It should be confirmed on the basis of the following diagnostic procedures: the transient ST-segment elevation derived from the electrocardiogram, formation of QS-complex in V4 right, hemodynamic monitoring, echocardiography and radionuclide ventriculography. Of all the diagnostic criteria the best sensitivity and specificity is achieved by a rise in right ventricular filling pressure, respectively, the ratio of the right to left ventricular filling pressure should be equal or higher than 0.65. Increasing importance is being attached to the diagnosis of right ventricular infarction, since the treatment of patients with predominant right ventricular insufficiency and low cardiac output differs considerably from that of left ventricular insufficiency. Comparing our experience with previous reports, it may be concluded that adequate fluid administration with positive inotropic drugs, particularly adrenergic substances, if required, is essential in the medical treatment of right ventricular infarction. Vasodilator therapy may be administered, too. If frequent bradyarrhythmias do not respond to usual treatment, atrial pacing or atrioventricular sequential pacing should be initiated.