Understanding right ventricular myocardial infarction in prehospital care

2021 ◽  
Vol 13 (2) ◽  
pp. 69-75
Author(s):  
Shamima Master
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Early Recognition ◽  
Prehospital Care ◽  
Specific Treatment ◽  
Inferior Myocardial Infarction ◽  
Treatment Pathway ◽  
Coronary Syndrome ◽  
Right Ventricular Myocardial Infarction ◽  
Current Guidelines

Right ventricular myocardial infarction (RVMI) most commonly occurs in relation to an inferior myocardial infarction. Patients with this condition where the culprit right coronary artery (RCA) is occluded have a poor prognosis. Early recognition and the specific treatment pathway for RVMI differ from the treatment for general acute coronary syndrome (ACS) which could help the paramedic to treat this condition more appropriately. This article explores current guidelines for the recognition and treatment of RVMI and the possible application of specific guidelines in a prehospital setting with regards to using right-sided precordial ECG, the administration of fluids and potential complications arising from vasodilatory drugs. Furthermore, the purpose of this article is to help educate and develop the understanding of RVMI in this high-risk subgroup who have an increased morbidity and mortality.

scholarly journals Retrospective analysis of complications and survival in patients with acute inferior myocardial infarction accompanied by right ventricular myocardial infarction

2019 ◽  
Vol 25 (1) ◽  
pp. 9-13
Author(s):  
Gintarė Neverauskaitė-Piliponienė ◽  
Rasa Kūgienė ◽  
Žaneta Petrulionienė ◽  
Pranas Šerpytis
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Cardiogenic Shock ◽  
Right Ventricular ◽  
Atrioventricular Block ◽  
Mortality Rates ◽  
Inferior Myocardial Infarction ◽  
Right Ventricular Myocardial Infarction ◽  
Long Term Mortality

Summary Right ventricular myocardial infarction (RVMI) accompanies about 30–50% of inferior wall myocardial infarction. RVMI is associated with higher rates of cardiogenic shock, atrioventricular block, atrial fibrillation, increased mortality rates. The topic requires a scientific update, as only a few studies have been made on RVMI during the past decade. We aimed to analyse the impact of RVMI on inferior myocardial infarction. Design and methods: Retrospective study included 310 patients with documented inferior myocardial infarction (with and without RVMI) between January 2013 and January 2014. Data on baseline characteristics, mortality, in-hospital complications: cardiogenic shock and rhythm and conduction disorders was collected. Results: In 102 (32.9%) patients with inferior myocardial infarction, RVMI was present and 208 (67.1%) cases were without RVMI involvement. RVMI patients had higher rate of rhythm and conduction disturbances than patients without RVMI involvement: atrioventricular block (OR 3.8, 95% CI 2.0–7.1, p < 0.001), atrial fibrillation (OR 1.6, 95% CI 0.9–2.9, p = 0.001), also higher incidence of cardiogenic shock (OR 2.6, 95% CI 1.7–3.9, p < 0.001). Mortality rates after 24 months were higher in RVMI group (OR 1.8, 95% CI 1.2–3.8, p = 0.034). No significant difference was found on in-hospital mortality. Conclusions: Right ventricular involvement complicates the long-term mortality and outcomes after inferior myocardial infarction. It is related to a higher incidence of in-hospital complications, especially I–III degree AV block and atrial fibrillation. However, influence on long-term mortality needs further investigation.

scholarly journals Right Ventricular Myocardial Infarction as an Independent Predictor of Prognosis in Acute Inferior Myocardial Infarction

2018 ◽  
Vol 26 ◽  
pp. 8-13
Author(s):  
Nazmul Huda ◽  
Zahidus Sayeed ◽  
ARMS Ekram ◽  
MMR Khan ◽  
MK Rahman
Keyword(s):  
Myocardial Infarction ◽  
Relative Risk ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Right Ventricular ◽  
Inferior Myocardial Infarction ◽  
Major Complications ◽  
Right Ventricular Myocardial Infarction ◽  
Acute Inferior Myocardial Infarction

Background: Acute inferior myocardial Infarction frequently involves the right ventricle and associated with significant morbidity and mortality. We hypothesized that right ventricular involvement may affect the prognosis of patients with inferior myocardial infarctions.Methodology: In 100 consecutive patients admitted to the hospital with acute inferior myocardial infarction, we assessed the incidence and prognostic factors for in-hospital outcome. RVMI (Right ventricular myocardial infarction) was diagnosed by ≥1mm ST elevation in lead V4R in right sided electrocardiogram.Result: RVMI was found in 31(31%) of patients of acute inferior myocardial infarctions. Major complications as hypotension and cardiogenic shock occurred in 96.7% and 64.5% patients respectively and in-hospital mortality was 41.9%. Whereas major complications as hypotension and cardiogenic shock occurred in 10.1% and 2.8% patients respectively and in hospital mortality was 2.8% of patients without right ventricular infarction among the inferior myocardial infarction. Multiple logistic regression analysis showed right ventricular infarction to be independent of and superior to all other clinical variables available on admission for the prediction of in hospital mortality (relative risk 88.37 percent, 95% confidence interval 7.33 to 1064.80; p=0.000) and major complications as hypotension (relative risk 394.22, 95% confidence interval 32.04 to 4849.07; p=0.000) and cardiogenic shock (relative risk 272.36, 95% confidence interval, 16.38 to 4526.35; p=0.000).Conclusion: RVMI commonly occurs in inferior myocardial infarction. It is a strong and independent predictor of major complications and in-hospital mortality. Early detection and appropriate monitoring can reduce its high mortality rate.TAJ 2013; 26: 8-13

scholarly journals P111: Kussmaul's sign for the diagnosis of right ventricular myocardial infarction

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S105-S105
Author(s):  
E. Dubé ◽  
M. Crozier ◽  
A. Middleton ◽  
B. Best
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Early Recognition ◽  
Meta Analysis ◽  
Right Ventricular Dysfunction ◽  
Reference Standards ◽  
Subset Analysis ◽  
Cochrane Database ◽  
Right Ventricular Myocardial Infarction ◽  
Full Text Review

Introduction: Kussmaul's sign, the absence of a drop in JVP or a paradoxical increase in JVP on inspiration, can be elicited clinically as an indicator of right ventricular myocardial infarction (RVMI). RVMI poses unique diagnostic and management challenges. It complicates 30-50% of inferior MI and is associated with increased mortality when compared to inferior MI without RV involvement. Early recognition allows maintenance of preload by avoiding use of nitroglycerin, diuretic and narcotic medication, and treatment with fluids and vasopressors. We reviewed the evidence for Kussmaul's sign for diagnosis of RVMI. Methods: We conducted a librarian assisted search using PubMed, Medline, Embase, the Cochrane database, relevant conference abstracts from 1965 to October 2019. No restrictions for language or study type were imposed. All studies with patients presenting with acute myocardial infarction were reviewed. Two independent reviewers extracted data from relevant studies. Studies were combined when similar study populations were present. Study quality was assessed using the QUADAS-2 tool. Random effects meta-analysis was performed using metaprop in Stata for the 3 reference standards combined. Subset analysis for each of the 3 reference standards was completed. Results: We identified 122 studies: 10 were selected for full text review. Eight studies had comparable populations with a total of 469 consecutive patients admitted to the coronary care unit with acute inferior myocardial infarction and were included in the analysis. Prevalence of RVMI was 36% (CI 95% 31.8–40.5). References standards for the diagnosis of RVMI included echocardiography, 16 lead ECG and haemodynamic studies. A gold standard for diagnosis of RVMI is lacking and thus the reference standards were combined. Kussmaul's sign had a sensitivity of 69.3% (CI 95% 46.3 - 85.5, I2- 86.7%), specificity of 95.1% (CI 95% 75.6 - 99.2, I2- 89.3%) and LR + 14.1 (CI 95% 2.6-73.2). Subset analysis of echocardiography, ECG and haemodynamic studies revealed sensitivity of 45%, 77% and 82% (I2- 62%, N/A, 70%) respectively and specificity of 92%, 84% and 92% (I2- 86%, N/A, 86%). Conclusion: Kussmaul's sign is specific for acute right ventricular myocardial infarction and may serve as an important clinical sign of right ventricular dysfunction requiring preload preserving management.

scholarly journals Right Ventricular Myocardial Infarction : Presentation and Acute Outcomes

2018 ◽  
Vol 25 ◽  
pp. 42-46
Author(s):  
MN Huda ◽  
MZ Sayeed ◽  
MK Rahman ◽  
MMR Khan ◽  
ARMS Ekram
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Tertiary Care ◽  
Inferior Wall ◽  
Inferior Myocardial Infarction ◽  
Cross Sectional ◽  
Right Ventricular Infarction ◽  
Right Ventricular Myocardial Infarction ◽  
Number Of Patients ◽  
Ventricular Infarction

Right Ventricular Infarction (RVI) complicating inferior wall myocardial infarction (MI) is common and associated with significant morbidity and mortality. We try to systematically assess the incidence, clinical presentation and in hospital outcomes of right ventricular myocardial infarction in a tertiary-care set up. This study was a descriptive, cross sectional observational series of consecutive patients with RVMI. All patients with acute inferior myocardial infarction (n=100) were enlisted. RVMI was diagnosed by ≥1mm ST elevation in lead V4R in right sided electrocardiogram. RVI occurred in 31% (n=31) of patients of acute inferior infarctions. Patients with isolated inferior myocardial infarction served as controls (n=69). Echocardiography was performed within 24 hours of admission. From both groups, 51% were qualified for thrombolysis. The incidence of hypotension (96.7%), cardiogenic shock (64.5%), bradycardia and heart block were much higher in RVI than in inferior myocardial infarction. Clinically manifest RV dysfunction (raised jugular venous pulse, hypotension and tricuspid regurgitation) and right ventricular dilatation detected by echocardiography was seen in a variable number of patients. In hospital mortality rate was significantly higher (n=13, 41.9%) in right ventricular infarction group than in inferior myocardial infarction group (n=2, 2.9%)TAJ 2012; 25: 42-46

scholarly journals The Efficacy of Thrombolytic Therapy in Inferior Myocardial Infarction with Damage to the Right Ventricular

2021 ◽  
Vol 17 (2) ◽  
pp. 233-238
Author(s):  
E. S. Mazur ◽  
V. V. Mazur ◽  
N. S. Kuznetsova ◽  
R. M. Rabinovich ◽  
K. S. Myasnikov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Thrombolytic Therapy ◽  
Right Ventricular ◽  
False Positive ◽  
Inferior Myocardial Infarction ◽  
St Segment ◽  
Right Ventricular Myocardial Infarction ◽  
Medial Segment ◽  
The Right

Aim. To study the results of thrombolytic therapy and accuracy of electrocardiographic assessment of thrombolysis efficiency in inferior myocardial infarction with and without right ventricular lesion.Material and methods. The118 patients with inferior myocardial infarction were included in this study. They received TLT in the first 12 hours of the disease. The dynamics of ST-segment in 90 minutes from the TLT start and coronary angiography data were analyzed.Results. Right ventricular myocardial infarction (RVMI) was diagnosed in 49 (41.5%) of 118 patients by echocardiography. Patients with and without RVMI did not differ in age, gender and comorbidities, but patients with RVMI were more likely to have arterial hypotension, atrioventricular block, and atrial fibrillation. All patients with RVMI had occlusion of the right coronary artery (RCA) in the proximal (34.7%) or medial segment (65.3%). Occlusion of the circumflex coronary artery was found in 20 (29.0%) patients without RVMI, and RCA occlusion - in other patients. The infarction-associated artery blood flow equal TIMI 2-3 was found in 17 (34.7%) patients with RVMI and in 46 (66.7%) patients without RVMI (p<0.005). ST-segment decrease by 50% or more in 90 minutes from the TLT was found in 35 (71.4%) patients with RVMI and in 49 (71.0%) patients without RVMI (p>0.05). The false-positive assessment of thrombolysis efficiency was noted in patients with and without RVMI in 21 (42.9%) and 11 (15.9%) cases (p <0.005), respectively. There were no false-positive assessments in patients with RVMI when using ST-segment decrease to the isoline.Conclusion. TLT should be considered effective in patients with inferior myocardial infarction with the right ventricle lesion, if ST-segment decreases to isoline in 90 minutes from the TLT start.

scholarly journals Clinical profiling of right ventricular infarction in patients with acute inferior wall myocardial infarction

2019 ◽  
Vol 6 (1) ◽  
pp. 35
Author(s):  
Vinod Khandait ◽  
Suresh Sarwale ◽  
Chandrashekhar Atkar ◽  
Harshwardhan Khandait
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Prospective Observational Study ◽  
Early Recognition ◽  
Inferior Wall ◽  
Coronary Risk Factors ◽  
Right Ventricular Infarction ◽  
Right Ventricular Myocardial Infarction ◽  
The Difference ◽  
Ventricular Infarction

Background: Incidence of Right Ventricular Myocardial Infarction (RVMI) associated with Inferior Wall Myocardial Infarction (IWMI) is reported to be quite high (30%-50%). To diagnose coexisting RVMI is important, since its early recognition and proper treatment reduces overall morbidity and mortality in IWMI. Author assessed the incidence and clinically profiled patients with right ventricular infarction in acute inferior wall myocardial infarction and analysed the effects of RVMI on clinical outcome of IWMI.Methods: A total of 150 patients of IWMI were evaluated in the present hospital based prospective observational study over duration of two years. They were evaluated for coronary risk factors like diabetes mellitus, hypertension, smoking, obesity, alcohol and dyslipidemia. Twelve-lead ECG, cardiac enzyme assay and echocardiography were undertaken in all the participants.Results: Of the total 150 patients, 45 (30%) patients had right ventricular myocardial infarction (RVMI). Complications were significantly lower in patients with isolated IWMI as compared to patients with IWMI and associated RVMI except pulmonary edema (p<0.05). Of the total 22 (14.67%) deaths in the present study, 18 (12%) had associated RVMI and 4 (2.66%) isolated IWMI, the difference being statistically significant.Conclusions: Involvement of right ventricle increases rate of complications as well as the mortality rate in patients with inferior wall myocardial infarction.

scholarly journals Importance of early recognition and treatmant of right ventricular myocardial infarction

2012 ◽  
Vol 31 (4) ◽  
pp. 29-33
Author(s):  
Mirjana Tomić ◽  
Gordana Vukčević-Milošević ◽  
Jasminka Kostić ◽  
Marija Boričić ◽  
Gabrijela Nikčević ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Early Recognition ◽  
Right Ventricular Myocardial Infarction

scholarly journals А new electrocardiographic criterion in diagnosis right ventricular myocardial infarction

2021 ◽  
Vol 22 (3) ◽  
pp. 24-31
Author(s):  
E. S. Mazur ◽  
V. V. Mazur ◽  
R. M. Rabinovich ◽  
N. S. Kuznetsova ◽  
K. S. Myasnikov
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Predictive Value ◽  
Inferior Myocardial Infarction ◽  
Negative Results ◽  
St Segment ◽  
Right Ventricular Myocardial Infarction ◽  
Surface Ecg ◽  
Ventricular Infarction ◽  
The Right

The aim of this study is to identify the features of ST-changes in 12-leads surface ECG, which help to diagnose the right ventricular involvement in inferior myocardial infarction. The study included 145 patients with inferior myocardial infarction, the right ventricular infarction (RVI) was detected by echocardiography in 62 (42.8%) patients. ST segment depression in lead aVL was deeper than in lead V3 in 93.5% of patients with RVI. This feature is revealed in 4.9% patients with inferior myocardial infarction without RVI only. The sensitivity of this criterion for diagnosis RVI is 93.5%, the specificity is 95.2%, the predictive value of positive and negative results make up 93.5 and 95.2%.

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