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 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.

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 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 Isolated right ventricular myocardial infarction: a case report

2020 ◽  
Author(s):  
Adeogo Akinwale Olusan ◽  
Paul Francis Brennan ◽  
Paul Weir Johnston
Keyword(s):  
Myocardial Infarction ◽  
Computed Tomography ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Right Ventricular ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Left Circumflex Artery ◽  
Right Ventricular Myocardial Infarction ◽  
Percutaneous Coronary

Abstract Background Isolated right ventricular myocardial infarction (RVMI) due to a recessive right coronary artery (RCA) occlusion is a rare presentation. It is typically caused by right ventricle (RV) branch occlusion complicating percutaneous coronary intervention. We report a case of an isolated RVMI due to flush RCA occlusion presenting via our primary percutaneous coronary intervention ST-elevation myocardial infarction pathway. Case summary A 61-year-old female smoker with a history of hypercholesterolaemia presented via the primary percutaneous coronary intervention pathway with sudden onset of shortness of breath, dizziness, and chest pain while walking. Transradial coronary angiography revealed a normal left main coronary artery, large left anterior descending artery that wrapped around the apex and dominant left circumflex artery with the non-obstructive disease. The RCA was not selectively entered despite multiple attempts. The left ventriculogram showed normal left ventricle (LV) systolic function. She was in cardiogenic shock with a persistent ectopic atrial rhythm with retrograde p-waves and stabilized with intravenous dobutamine thus avoiding the need for a transcutaneous venous pacing system. A computed tomography pulmonary angiogram demonstrated no evidence of pulmonary embolism while an urgent cardiac gated computed tomography revealed a recessive RCA with ostial occlusive lesion. A cardiac magnetic resonance imaging confirmed RV free wall infarction. She was managed conservatively and discharged to her local district general hospital after 5th day of hospitalization at the tertiary centre. Discussion This case describes a relatively rare myocardial infarction presentation that can present with many disease mimics which can require as in this case, a multi-modality imaging approach to establish the diagnosis.

Remote right ventricular myocardial infarction mimicking chronic pericardial constriction

1982 ◽  
Vol 103 (5) ◽  
pp. 912-914 ◽  
Author(s):  
Samuel Butman ◽  
Harold G Olson ◽  
Wilbert S Aronow ◽  
Kenneth P Lyons
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Right Ventricular Myocardial Infarction

scholarly journals Early Implementation of Veno-Venous Hemofiltration and Use of Rotational Atherectomy in a Patient with ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock- case report.

2020 ◽  
Author(s):  
Monika Durak ◽  
Marek Tomala ◽  
Bartłomiej Nawrotek ◽  
Andrzej Machnik ◽  
Jacek Legutko
Keyword(s):  
Myocardial Infarction ◽  
Acute Kidney Injury ◽  
Case Report ◽  
Cardiogenic Shock ◽  
Right Ventricular ◽  
Kidney Injury ◽  
Novel Treatment ◽  
Early Implementation ◽  
Right Ventricular Myocardial Infarction ◽  
St Elevation

We report a patient with cardiogenic shock (CS) in the course of acute right ventricular myocardial infarction (MI). Our case highlights the use of continuous veno-venous hemofiltration as a novel treatment option for acute kidney injury in the setting of CS and the use of rotational_atherectomy in patients with MI.

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