Ragavendra
R. Baliga, M.D
Assistant
Professor
Division
of Cardiology
University
Of Michigan
| 63-year old woman presented with central chest pain of two hours duration. On examination her blood pressure was 90/60 mm Hg, she had a weak pulse, distended neck veins with elevated jugular venous pressure, normal first and second heart sounds and lung fields were clear on auscultation. | |
| Her EKG excludes inferior wall myocardial infarction. | |
| Right precordial leads, in particular lead V4R, should be recorded in this patient at the time of admission. | |
| The clinical triad of hypotension, elevated jugular venous pressure and clear lungs in patients with inferior wall MI is characteristic of right ventricular ischemia. | |
| The presence of distended neck veins alone is sensitive and specific for right ventricular ischemia in patients with inferior wall MI. | |
| When there are non-diagnostic findings echocardiography can be helpful in making the diagnosis of right ventricular ischemia. | |
| The benefit of thrombolysis is minimal when inferior wall MI is complicated by right ventricular ischemia. | |
| In ST-elevation MI patients benefit the most from thrombolysis when treated early after the onset of symptoms. | |
| Nitrates should be avoided in this patient. | |
| As this patient's jugular venous pressure is elevated, intravenous fluids such as normal saline should not be administered to treat the hypotension. | |
| If the cardiac output fails to improve after administration 0.5 to 1L of fluids, inotropic support with dobutamine hydrochloride should be initiated promptly. | |
| Atrio-ventricular sequential pacing often improves hypotension when RV infarct is accompanied by a high-degree atrioventricular block. | |
| Atrial fibrillation may occur in up to a third of the patients with right ventricular ischemia. | |
| When left ventricular dysfunction accompanies right ventricular ischemia, the right ventricular function is further compromised. | |
| The right coronary artery usually supplies most of the right ventricular myocardium. | |
| Most patients with proximal right coronary artery occlusion have hemodynamically significant right ventricular infarction. | |
| Right ventricular ischemia is associated with increased short-term morbidity and mortality as well as adverse long term-outcome. | |
| Clinical and hemodynamic recovery occurs eventually in patients with right ventricular dysfunction. | |
Produced
by the Learning Resource Center Office of Medical EducationUniversity
of Michigan Medical School
Copyright 2001 by the University of Michigan Board of Regents. All rights reserved.
Copyright 2001 by the University of Michigan Board of Regents. All rights reserved.