Right ventricular infarction. Aids to recognition

Right ventricular infarction is often associated with myocardial infarction located in the inferior or posterior left ventricular wall. It should be suspected if a patient has distended neck veins with Kussmaul's sign, ST-segment elevation in the V4R precordial lead, possible heart block, and extreme sensitivity to preload reducers such as nitroglycerin and diuretics (administration of which may lead to hypotension). Measures such as administration of fluid (with Swan-Ganz monitoring), inotropic support with dobutamine (Dobutrex), and atrioventricular sequential pacing may be of benefit in hypotensive patients. Mortality can be significant, especially when there is hemodynamic compromise; however, reperfusion as a result of thrombolytic therapy or angioplasty may have a salutary effect. Early investigations imply that long-lasting benefit is obtained from opening an infarct-related artery.