Rapid Hemodynamic Improvement in Right Ventricular Infarction After Coronary Angioplasty

doi:10.1378/chest.94.1.197

Chest

Volume 94, Issue 1, July 1988, Pages 197-199

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A patient is described where the hemodynamic disturbance caused by a right ventricular infarction was promptly corrected after coronary angioplasty (PTCA). This indicates that reperfusion may be useful in managing hypotension due to predominant right ventricular infarction.

Section snippets

Case Report

A 53-year old white man presented to the Emergency Room of Robert Wood Johnson University Hospital complaining of substernal chest pain for approximately 30 minutes, accompanied by diaphoresis, and lightheadedness. He denied previous history of chest pain or other cardiac history. He had had hypertension for ten years and a 35 pack-year history of smoking. His medications included metoprolol, 100 mg daily and thiazide, 25 mg daily. On arrival, an electrocardiogram showed ST-segment elevation in

Discussion

Although right ventricular infarction has been described for many years at autopsy, the hemodynamic impact was not well recognized until the report of Cohn et al⁴ in 1974. Since it is essential to recognize early signs of predominant right ventricular infarction because it may require a unique form of therapy, several clinical and electrocardiographic studies have attempted to detect right ventricular involvement in acute myocardial infarction.⁵

Necrosis of a large proportion of the right

References (7)

GB Cintron et al.
Bedside recognition, incidence and clinical course of right ventricular infarction
Am J Cardiol
(1981)
MB Forman et al.
Electrocardiographic changes associated with isolated right ventricular infarction
J Am Coll Cardiol
(1984)
AE Moreyra et al.
Nondominant right coronary artery occlusion presenting with isolated right ventricular infarction and ventricular fibrillation
Am J Med
(1986)

There are more references available in the full text version of this article.

Cited by (14)

ACC/AHA Guidelines for the Management of Patients with Acute Myocardial Infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction)
1996, Journal of the American College of Cardiology
Right ventricular infarction
1992, Cardiology Clinics
Right ventricular myocardial infarction, long unrecognized because of inadequate diagnostic methods and unwarranted assumptions regarding the dispensability of the right ventricle, is now known to occur in 30% to 40% of patients with inferior infarction and is clearly associated with anterior left ventricular infarction as well as inferior infarction. Right ventricular systolic and diastolic dysfunction, exacerbated by pericardial restraint and concomitant left ventricular dysfunction, accounts for the cardiogenic shock and dramatic preload dependence frequently encountered. Right ventricular infarction may be suspected by clinical examination and can be confirmed using well-defined electrocardiographic, radionuclide, echocardiographic, and hemodynamic criteria. Once diagnosed, right ventricular infarction requires specific medical management, including the careful use of volume expansion and inotropic therapy. Mechanical and surgical interventions are of potential value in treating hemodynamic disturbances and characteristic complications. With appropriate management, patients with right ventricular infarction may enjoy a favorable prognosis.
V guidelines of the brazilian society of cardiology on acute myocardial infarction treatment with st segment elevation
2015, Arquivos Brasileiros de Cardiologia
Acute complications of myocardial infarction
2009, Echocardiography in Acute Coronary Syndrome: Diagnosis, Treatment and Prevention
The 4th Guidelines on the Treatment of Acute ST-segment Elevation Myocardial Infarction of the Brazilian Society of Cardiology
2009, Arquivos Brasileiros de Cardiologia
Instructions on the treatment of acute myocardial infarction
2004, Arquivos Brasileiros de Cardiologia

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Selected ReportsRapid Hemodynamic Improvement in Right Ventricular Infarction After Coronary Angioplasty

Section snippets

Case Report

Discussion

Am J Cardiol

J Am Coll Cardiol

Am J Med

Selected Reports
Rapid Hemodynamic Improvement in Right Ventricular Infarction After Coronary Angioplasty