Early diagnosis of right ventricular or posterior infarction associated with inferior wall left ventricular acute myocardial infarction

CONTEXT AND OBJECTIVE: There is uncertainty regarding the risk of major complications in patients with left ventricular (LV) infarction complicated by right ventricular (RV) involvement. The aim of this study was to evaluate the impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular myocardial infarction. DESIGN AND SETTING: Prospective cohort study, at Emergency Care Unit of Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. METHODS: 183 patients with acute myocardial infarction participated in this study: 145 with LV infarction alone and 38 with both LV and RV infarction. The presence of complications and hospital death were compared between groups. RESULTS: 21% of the patients studied had LV + RV infarction. In this group, involvement of the dorsal and/or inferior wall was predominant on electrocardiogram (p < 0.0001). The frequencies of Killip class IV upon admission and 24 hours later were greater in the LV + RV group, along with electrical and hemodynamic complications, among others, and death. The probability of complications among the LV + RV patients was 9.7 times greater (odds ratio, OR = 9.7468; 95% confidence interval, CI: 2.8673 to 33.1325; p < 0.0001) and probability of death was 5.1 times greater (OR = 5.13; 95% CI: 2.2795 to 11.5510; p = 0.0001), in relation to patients with LV infarction alone. CONCLUSIONS: Patients with LV infarction with RV involvement present increased risk of early morbidity and mortality.

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Value of ST elevation in lead III greater than lead II in inferior wall acute myocardial infarction for predicting in-hospital mortality and diagnosing right ventricular infarction

The American Journal of Cardiology ◽

10.1016/s0002-9149(00)01401-6 ◽

2001 ◽

Vol 87 (4) ◽

pp. 448-450 ◽

Cited By ~ 27

Author(s):

Jacqueline Saw ◽

Cheryl Davies ◽

Anthony Fung ◽

John J. Spinelli ◽

John Jue

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Right Ventricular ◽

Inferior Wall ◽

Right Ventricular Infarction ◽

St Elevation ◽

Ventricular Infarction

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Left Ventricular and adjacent Right ventricular Pseudoaneurysms post acute myocardial infarction communicating via a Ventricular Septal Defect

10.22541/au.160812826.67804259/v1 ◽

2020 ◽

Author(s):

Kevin Kang ◽

John Wilson ◽

Jeffrey Friedel ◽

Angel Flores

Keyword(s):

Myocardial Infarction ◽

Right Ventricular ◽

Color Doppler ◽

Fatal Outcome ◽

Left Ventricular ◽

Inferior Wall ◽

Papillary Muscle Rupture ◽

Mechanical Complications ◽

Muscle Rupture ◽

Echocardiographic Images

The rare but deadly post myocardial infarction (MI) mechanical complications are categorized as ventricular free wall rupture, ventricular septal rupture (VSD) and papillary muscle rupture in decreasing order of incidence. The incidence of the mechanical complications has been mitigated by early revascularization in recent years but mortality remains high. The cardiac rupture if contained by clot, scar and pericardium leads to a LV pseudoaneurysm that delays or diminishes the fatal outcome. Mechanical complications and pseudoaneurysm are recognized by echocardiography. We report a previously unreported occurrence of a pseudoaneurysm involving the adjacent walls of both the ventricles, LV basal and inferoseptal walls and the adjacent right ventricular inferior wall (RV). The LV and RV communicated via a hole in the pseudoaneurysmal wall. The echocardiographic images initially showed the LV pseudoaneurysm bulging into the RV rather than into the pericardium. The color Doppler showed shunting through the LV pseudoaneurysm into the RV creating an unusual VSD. The CT angiograms corroborated the echo findings. The LV pseudoaneurysm had a tear in it and this led to bleeding not into pericardium but into the adjacent RV pseudoaneurysm, hence creating a very unusual VSD. Subsequently, our patient went for surgical repair of pseudoaneurysm and the surgical findings confirmed the imaging findings that there was a massive LV pseudoaneurysm from the inferior and inferoseptal walls, the adjacent RV wall was involved with the pseudoaneurysm and a communication between LV pseudoaneuysm sac and the RV was seen. Such pathology has not been described in the past.

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Conservative Management of Subacute Contained Left Ventricular Rupture after Acute Myocardial Infarction

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0038-1669784 ◽

2018 ◽

Vol 03 (01) ◽

pp. 034-038

Author(s):

Bharat Goud C ◽

Johann Christopher

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Color Doppler ◽

Regional Wall Motion ◽

Left Ventricular ◽

Mechanical Complication ◽

Inferior Wall ◽

Early Reperfusion ◽

St Segment Elevation ◽

Myocardial Wall

AbstractLeft ventricular free wall rupture (LVFWR) is a near-fatal mechanical complication of acute myocardial infarction in which an early diagnosis and emergency surgery should be of utmost priority for successful treatment. LVFWR is generally perceived to be universally fatal. Majority of LVFWR patients developing cardiac tamponade die rapidly, while in minority of cases the development of tamponade may be sufficiently slow to allow for diagnosis and successful intervention. In this article, the authors report a case of a 63-year-old male patient diagnosed with an inferoposterior wall myocardial infarction treated with early reperfusion thrombolytic therapy presenting 3 days later with diagnosis of subacute LVFWR. Patient had a history of relapse of chest pain which was severe and prolonged with 2 to 3 mm saddle-shaped ST-segment elevation in lateral leads, detected on a routine electrocardiogram, which led to an urgent bedside transthoracic echocardiogram (TTE). TTE showed regional wall motion abnormality in form of akinetic basal inferior-wall, a small echodense pericardial effusion, and a canalicular tract from endocardium to pericardium, through which color-Doppler examination suggested blood crossing the myocardial wall. A cardiac magnetic resonance imaging further reinforced the possibility of contained LVFWR.

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