Right ventricular infarction

Abstract

Right ventricular infarction is present in up to 80% of autopsy specimens following fatal myocardial infarction. The clinical features suggestive of right ventricular infarction such as raised systemic venous pressure, clear lung fields, hypotension and atrio‐ventricular nodal disturbances usually occur in association with inferior myocardial infarction, with an incidence of 30–50%. Kussmaul‘s sign of a paradoxical rise in the jugular venous pressure wave on inspiration is both sensitive and specific for right ventricular infarction. A 1mm rise in the V4R ST segment on ECG has a positive predictive value for right ventricular infarction of over 70%, increasing to 90% with the addition of ST elevation in leads VSR and V6R. ECG changes are often transient. Acute management of right ventricular infarction includes fluid loading and inotropic support with dobutamine as necessary, with avoidance of vasodilators and diuretics. Mortality from acute myocardial infarchon is increased by right ventricular infarction, but may be lessened by thrombolytic therapy in eligible patients.