Right ventricular infarction

Right ventricular infarction complicates up to half of inferior left ventricular infarctions. The term represents a spectrum of disease from mild, asymptomatic right ventricular dysfunction to cardiogenic shock, and it includes transient ischemic myocardial dysfunction as well as myocardial necrosis. Right ventricular infarction is associated with considerable morbidity and mortality, and its presence defines a high-risk subgroup of patients with inferior left ventricular infarction. Diagnosis of this condition requires a high degree of suspicion based on clinical findings and the early recording of the electrocardiogram through right precordial leads, as well as elevated right-sided filling pressures out of proportion to left-sided filling pressures. The proper management of right ventricular infarction requires sustaining adequate right ventricular preload with volume loading and maintenance of atrioventricular synchrony, reduction of right ventricular afterload (particularly when left ventricular dysfunction is present), and inotropic support of the right ventricle. Early reperfusion with fibrinolytic therapy or direct angioplasty is also warranted. Survivors of right ventricular infarction generally have a restoration of normal right ventricular function with resolution of hemodynamic abnormalities.