Incidence and bedside diagnosis of haemodynamically significant right ventricular infarction

The incidence, diagnosis and clinical course of haemodynamically significant right ventricular infarction (RVI) were assessed prospectively in 90 patients with their first acute inferior myocardial infarction. The haemodynamic criteria for RVI were defined as a mean right atrial pressure of 10 mmHg or more and a mean right atrial pressure equal to or greater than the mean pulmonary capillary wedge pressure. Twenty-six patients (29%) had haemodynamic evidence of RVI (group A) whereas 64 (71%) did not meet the criteria (group B). ST-segment elevation in lead V4R was observed in 25 patients (96%) with haemodynamic evidence of RVI and in 15 (23%) without (P less than 0.001). The jugular venous pressure (JVP) was found to be elevated in 24 of the 26 group A and in 7 of the 64 group B patients (P less than 0.001). Kussmaul's sign was present in 21 group A and 3 group B patients (P less than 0.001). Of the clinical signs, elevation of the JVP with clear lung fields on the chest radiograph had the best predictive value (92%) for haemodynamically significant RVI. The ECG was highly sensitive (96%) but less specific (77%) and had a low predictive value (63%) for haemodynamically significant RVI. Hypotension and complete atrioventricular block occurred more frequently in group A patients (P less than 0.001 and P less than 0.01 respectively). The hospital mortality rate was similar in both groups.