Acute Myocardial Infarction Caused by an Anomalous Right Coronary Artery Occlusion Presenting with Precordial ST Elevation

Acute coronary syndrome with precordial ST segment elevation is usually related to left anterior descending artery occlusion, although isolated right ventricular infarction has been described as a cause of ST elevation in V1–V3 leads. We present a case of a patient with previous inferior wall infarction and new acute ST elevation myocardial infarction (STEMI) due to proximal right coronary thrombotic occlusion resulting in right ventricular infarction with precordial ST elevation and sinus node dysfunction. The patient was treated with successful rescue angioplasty achieving resolution of acute symptoms and electrocardiographic abnormalities.

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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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STUDY OF RIGHT VENTRICULAR INFARCTION IN INFERIOR WALL MYOCARDIAL INFARCTION AT MEDICINE DEPARTMENT OF GMC, BETTIAH BIHAR

10.36106/ijsr/3223417 ◽

2020 ◽

pp. 1-2

Author(s):

Mahendra Kumar ◽

Dharmendra Prasad ◽

Parshuram Yugal ◽

Debarshi Jana

Keyword(s):

Myocardial Infarction ◽

Right Ventricle ◽

Right Ventricular ◽

Left Ventricular ◽

Inferior Wall ◽

Medicine Department ◽

Right Ventricular Infarction ◽

St Elevation ◽

Ventricular Infarction ◽

Electrocardiogram Ecg

Background: Right ventricular infarction (RVI) is frequently associated with inferior wall myocardial infarction (MI). Methods: This study was designed to identify the burden of RVI in patientspresenting with inferior wall MI (n=50) byright precordial electrocardiogram (ECG) and comparing it with echocardiography (ECHO). Results: Their mean age was (54.5 ± 11.9 years); there were 42 males. ST elevation of greater than 1 mm in rightprecordial leads (RPL) suggestive of RVI was evident in 16 (32%) cases. Among the RPL (V3R - V6R) V4R and V5Rshowed sensitivity of 87.5%. The 12-lead ECG finding of ST-elevation greater than 1 mm in lead III and lead III/IIgreater than 1, had poor sensitivity (75%), specificity (88.2%) compared to ST- elevation of greater than 1 mm in any ofthe RPL (100%). Both the echocardiography criteria, namely right ventricular end-diastolic dimension (RVEDD) greaterthan 25 mm (92.3%) and the ratio of RVEDD to left ventricular end-diastolic dimension (RVEDD/LVEDD) greaterthan 0.7 (90%) indicating right ventricle (RV) dilatation was observed significantly more frequently in RVI group. Conclusions: RVI occurs in more than one-third of patients with acute inferior wall MI. All the patients with inferior wallMI should have RPL recorded as early as possible for evidence of RVI, of which V4R, V5R have the highest sensitivity.

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P264 Comparison of in-hospital mortality between acute inferior wall STEMI patients with right ventricular infarction and without right ventricular infarction undergoing a primary PCI in KCMH

European Heart Journal ◽

10.1093/ehjci/ehz872.088 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

Author(s):

S Preechawuttidej ◽

S Srimahachota

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Right Ventricular ◽

St Elevation Myocardial Infarction ◽

Hospital Death ◽

Inferior Wall ◽

Right Ventricular Infarction ◽

St Elevation ◽

Ventricular Infarction

Abstract Background Patients with acute inferior wall ST elevation myocardial infarction, if there is a right ventricular myocardial infarction involvement, they have pretended a worse prognosis with hemodynamic and electrophysiologic complications causing higher in-hospital morbidity and mortality. However most patients in previous studies were mainly treated with intravenous fibrinolysis and also studied in the Caucasian populations. Objectives To compare the in-hospital mortality rate of patients with acute inferior wall ST elevation myocardial infarction with and without right ventricular infarction involvement, whom were treated with primary percutaneous coronary intervention (PPCI). Methods The study was a retrospective descriptive study which enrolled patients with acute inferior wall ST elevation myocardial infarction who were treated with PPCI in our hospital from 1 January 2007 - 31 December 2016. Results Among 452 acute inferior wall ST elevation myocardial infarction patients who were treated with PPCI, there were 99 patients who had right ventricular infarction involvement, the in-hospital mortality rate was 23.2%, mainly due to cardiogenic shock, compared with 5.1 % in patients who had no right ventricular infarction (p < 0.001). Patients with right ventricular infarction had a significantly higher incidence of cardiogenic shock (48.5% versus 15.6%, P < 0.001), the lower number of left ventricle ejection fraction (51.15 ± 17.27% versus 55.79 ± 12.46%, p = 0.037), the higher incidence of complete heart block (33.3% versus 11.9%, p < 0.001) and ventricular tachycardia (15.2% versus 5.9%, p = 0.003). After adjustment for age, female sex, diabetes, hypertension, previous myocardial infarction, cardiogenic shock on admission, left ventricular ejection fraction, ventricular tachycardia and complete heart block, the right ventricular infarction remained the independent predictor of in-hospital death (adjusted hazard ratio, 1.69; 95% confidence interval, 0.38 to 7.48; P = 0.489) and significant independent predictor for 1-year mortality (adjusted hazard ratio, 2.76; 95% confidence interval, 1.08 to 7.03; P = 0.034). Conclusion Patients with acute inferior wall STEMI whom were treated with PPCI, if there was right ventricular infarction involvement, the in-hospital death and 1-year mortality were significantly higher than who were without right ventricular infarction.

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Right Ventricular Infarction in Inferior Wall Myocardial Infarction

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0037-1607056 ◽

2017 ◽

Vol 02 (03) ◽

pp. 029-034 ◽

Cited By ~ 1

Author(s):

Velam Vanajakshamma ◽

Kancherla Vyshnavi ◽

Kasala Latheef ◽

Rayi Ramesh ◽

Kodem DamodaraRao

Keyword(s):

Myocardial Infarction ◽

Right Ventricular ◽

Clinical Examination ◽

Inferior Wall ◽

Ventricular Ejection Fraction ◽

Right Ventricular Infarction ◽

Highly Sensitive ◽

Careful Clinical Examination ◽

St Elevation ◽

Ventricular Infarction

Background Right ventricular infarction (RVI) is common in patients with inferior wall myocardial infarction (IWMI). Right ventricular involvement increases mortality and morbidity in IWMI patients. Clinical presentation of RVI differs, and accordingly treatment and management of patients also differs. Aim To find out the frequency of RVI among patients with acute IWMI and to determine the utility of clinical examination, electrocardiography (ECG), and echocardiography (ECHO) in the diagnosis of RVI and its severity. Also o study the frequency and complications with reference to sex. Material and Methods One hundred patients with acute IWMI were recruited. Clinical examination, ECG with right precordial leads, and 2D ECHO (right ventricular end-systolic volume [RVESV] and right ventricular end-diastolic volume [RVEDV], right ventricular stroke volume [RVSV], RVESV index [RVESVI], RVEDV index [RVEDVI], RVSV index [RVSVI], and right ventricular ejection fraction [RVEF]) were done to diagnose RVI and its severity. RVI patients were divided into two groups basing on RVEF as severe RVI (EF < 35%) and mild RVI (EF > 35%). Results Forty-three (43%) patients had RVI. Thirty-one (72%) patients had mild RVI (EF > 35%) and 12 (28%) had severe RVI (EF < 35%). Clinical examination had less sensitivity (35%) and high specificity (93%) in the diagnosis of RVI whereas it was highly sensitive (100%) and specific (90%) in detecting severe RVI. Total ST elevation of ≥ 3 mm was highly sensitive (92%), and ≥ 5 mm was highly specific (94%) in detecting severe RVI. RVEF (p < 0.01), RVESVI (p < 0.01), RVEDVI (p < 0.01), RVSVI (p < 0.05), and total ST elevation (p < 0.01) were equally effective in detecting severe RVI. Case fatality rate in RVI was 7%. Proportional mortality rate in females was 67%, with higher mortality in females compared with males (p ≤ 0.05). Conclusion Right-sided leads should be taken in all cases of acute IWMI. Careful clinical examination, total ST elevation in V1, V2, V3R, V4R, ECHO RVESV, RVEDV, RVSV, RVEF, RVESVI, RVEDVI, and RVSVI are useful in detecting severe RVI. Complications were significantly associated with the severity of RVI. Mortality is high in females compared with males.

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