An unusual complication of acute myocardial infarction

Right ventricular infarction occurs exclusively as a complication of a transmural inferoseptal left ventricular infarction. Up to 50% of patients with transmural inferoseptal infarction may have associated right ventricular involvement. In the majority of cases, however, the right ventricular involvement is clinically silent. However, significant right ventricular infarction is being recognized with greater frequency. Clinically, distended neck veins and hypotension are frequent findings in acute right ventricular infarction and their presence should suggest the diagnosis. Damage to the right ventricle causes poor contractility and output, and thus the right ventricle functions more as a passive conduit to the left ventricle. The patient should lie with the bed flat to improve volume return to the right and left ventricles. Volume expansion is used when left ventricular filling pressure is low and there is clinical evidence of poor peripheral perfusion.