А new electrocardiographic criterion in diagnosis right ventricular myocardial infarction

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

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2021-04-12 ◽

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.

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Diagnostic value of standard electrocardiogram in acute right ventricular myocardial infarction

European Journal of Translational Myology ◽

10.4081/ejtm.2019.8184 ◽

2019 ◽

Vol 29 (2) ◽

Author(s):

Ali Taherinia ◽

Koorosh Ahmadi ◽

Mehran Bahramian ◽

Peyman Khademhosseini ◽

Zabihollah Taleshi ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Right Ventricular ◽

Significant Relationship ◽

Diagnostic Value ◽

P Value ◽

Right Ventricular Infarction ◽

St Segment ◽

Right Ventricular Myocardial Infarction ◽

Ventricular Infarction

Myocardial infarction (MI) (i.e., heart attack) is the irreversible death (necrosis) of heart muscle secondary to prolonged lack of oxygen supply (ischemia) which accounts for a large number of deaths in the hospital. Diagnosis of myocardial infarction is confirmed based on clinical manifestations and electrocardiographic changes along with increased cardiac enzymes. Electrocardiogram (ECG) is one of the safest and easiest methods in the first place. Therefore, this study aimed to investigate the diagnostic value of standard electrocardiogram in the diagnosis of acute right ventricular infarction following lower cardiac infarction. This research was carried out at a time interval of one and a half years to diagnose acute primary infarction. In this method, the diagnostic value of ST↓ in lead I, ST↓ in lead aVL and I ST↓ + aVL, compared with ST↑ in lead V4R was investigated for diagnosis of right ventricular infarction. ST↑ in the lead V4R is a gold standard for the detection of right ventricular MI. All the patients who had the inclusion criteria were allowed to participate in the study. A total of 66 patients participated in the study. Accordingly, 58 (87%) were male and 8 (13%) were female. The mean age of the population was 54.9 ± 11.41. According to the ST↑ standard in lead V4R, 26 patients (39%) had right ventricular myocardial infarction. There was no significant relationship between angina pectoris and premature infarction (P-Value = 0.869). In this study, the right ventricular was most commonly involved in right coronary artery (78%). There was no significant relationship between the occlusion of right coronary artery and right ventricular infarction in 60 patients (P-Value = 0.94). The results showed that electrocardiogram manifestations help determine the occlusion site and the area at risk (ST↓ in lead aVL and aVL + I, sensitivity = 96%). In myocardial infarction, symptoms such as the ST-Segment elevation in lead aVR and ST-Segment depression in the lower leads are possible. Accordingly, in the lower infarction, ST changes in the leads V1-V6 are helpful in detecting patients at risk. Thus, the use of electrocardiogram in acute myocardial infarction helps detect more invasive patients and prevents extensive myocardial damage and other complications.

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Right ventricular infarction: Relationships between ST segment elevation in V4R and hemodynamic, scintigraphic, and echocardiographic findings in patients with acute inferior myocardial infarction

American Heart Journal ◽

10.1016/0002-8703(81)90191-5 ◽

1981 ◽

Vol 101 (3) ◽

pp. 281-287 ◽

Cited By ~ 125

Author(s):

J. Candell-Riera ◽

J. Figueras ◽

V. Valle ◽

A. Alvarez ◽

L. Gutierrez ◽

...

Keyword(s):

Myocardial Infarction ◽

Right Ventricular ◽

Inferior Myocardial Infarction ◽

St Segment Elevation ◽

Right Ventricular Infarction ◽

St Segment ◽

Ventricular Infarction ◽

Acute Inferior Myocardial Infarction ◽

Echocardiographic Findings

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Clinical Outcome and Echocardiographic Evaluation of Inferior Myocardial Infarction with Right Ventricular Involvement

Cardiovascular Journal ◽

10.3329/cardio.v4i2.10457 ◽

2012 ◽

Vol 4 (2) ◽

pp. 132-138 ◽

Cited By ~ 1

Author(s):

B Guha ◽

AAS Majumder ◽

MNA Chowdhury ◽

MM Hossain ◽

AK Mandal

Keyword(s):

Myocardial Infarction ◽

Right Ventricular ◽

Clinical Signs ◽

Cost Effective ◽

Risk Groups ◽

Inferior Wall ◽

Right Ventricular Myocardial Infarction ◽

Ventricular Infarction ◽

Severity Of The Disease ◽

The Right

Background : Acute right ventricular myocardial infarction complicates inferior wall myocardial infarction with an incidence of 14-84%. ECG is the cornerstone in initial diagnosis as it is cost effective and done easily. Echocardiographic analysis of the right ventricular involvement can shed light on the severity of the disease. Hence we aimed to study right ventricular infarction in acute inferior wall myocardial infarction using right precordial lead as well as echocardiography. Methods: Present study is based on the analysis of 100 patients admitted to Coronary care unit of the National Institute of Cardiovascular Diseases & Hospital during July 2010 to June 2011, with acute inferior wall myocardial infarction. 12 lead ECG with thorough physical examination was done along with right precordial mapping. ST ³ 1mm in V4R was initial diagnostic of right ventricular involvement followed by echocardiographic assessment of RV and LV within 24 hours. Results: A total of 50 patients showed right ventricular involvement with V4R being the sensitive lead. Echocardiography showed mean RVEF of patients with 29.5 % ± 9.5 in comparison of 44.9%±12.2 without right ventricular involvement. Right ventricular involvement presented with bradycardia (40%) and hypotension, 80% Kussmauls sign, 14% with complete heart block. Mortality in right ventricular involvement was 6 times higher than without right ventricular involvement (12 %). Conclusion: Clinical signs and symptomatology are not fully diagnostic of RVI in inferior wall acute MI. ECG can diagnose (using right precordial mapping) this condition very early. Echocardiography help to assess the right ventricular function high-risk groups for aggressive management like primary PCI. Early diagnosis will help in careful monitoring and management of such cases. DOI: http://dx.doi.org/10.3329/cardio.v4i2.10457 Cardiovasc. j. 2012; 4(2): 132-138

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Right Ventricular Myocardial Infarction : Presentation and Acute Outcomes

TAJ Journal of Teachers Association ◽

10.3329/taj.v25i0.37557 ◽

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

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Acute Isolated Right Ventricular Infarction: Unusual Presentation of Anterior ST-Segment-Elevation Myocardial Infarction

Texas Heart Institute Journal ◽

10.14503/thij-17-6581 ◽

2019 ◽

Vol 46 (2) ◽

pp. 151-154

Author(s):

Wayne W. Zhong ◽

Matthew Blue ◽

Andrew D. Michaels

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Right Ventricular ◽

Right Coronary Artery ◽

St Segment Elevation ◽

Right Ventricular Infarction ◽

St Segment ◽

Right Ventricular Myocardial Infarction ◽

Ventricular Infarction ◽

Electrocardiographic Leads

Acute right ventricular infarction presenting with ST-segment elevation in the anterior precordial electrocardiographic leads is an unusual event. Anterior ST-segment elevation typically suggests occlusion of the left anterior descending coronary artery. It should be recognized, however, that occlusion of a right coronary artery branch can cause isolated ST-segment elevation in leads V1 and V2 on a standard 12-lead electrocardiogram. We describe the cases of 2 patients who presented with acute chest syndrome with isolated ST-segment elevation in leads V1 and V2. Emergency coronary angiograms revealed that acute thrombotic occlusion of the right ventricular marginal branch of the dominant right coronary artery caused the clinical manifestations in the first patient, whereas occlusion of the proximal nondominant right coronary artery was the culprit lesion in the second patient. Both lesions caused right ventricular myocardial infarction. The patients underwent successful primary percutaneous coronary intervention. These cases illustrate the importance of carefully reviewing angiographic findings to accurately diagnose an acute isolated right ventricular myocardial infarction, which may mimic the electrocardiographic features of an anterior-wall myocardial infarction.

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