Right ventricular myocardial infarction: echocardiographic evidence among patients with inferior wall myocardial infarction

Abstract

Infark ventrikel kanan yang terutama terjadi sebagai komplikasi infark inferior merupakan entitas penyakit tersendiri dimana dapat terjadi gangguan hemodinamik mayor. Pemeriksaan hemodinamik, elektrokardiografi (EKG), radionuklid angiografi dan ekokardiografi digunakan untuk mengetahui keterlibatan ventrikel kanan pada infark inferior. Infark ventrikel kanan terjadi pada 30 sampai 50% kasus infark inferior. Kami telah melakukan penelitian pada 37 pasien dengan infark inferior akut (dengan metode non invasif) dengan tujuan menilai peranan ekokardiografi dalam diagnosis infark ventrikel kanan dan membandingkan sensitivitasnya terhadap EKG dan kriteria klinis. Pada ekokardiografi, 12 dari 37 pasien (32%) menunjukkan keterlibatan ventrikel kanan. Tanda Kussmaul terjadi pada 27% pasien dan menunjukkan sensitivitas 50%, spesifisitas 88%, dan ketepatan prediksi 70%. Hantaran prekordial kanan pada EKG (V 3 R dan V 4 R) mendeteksi infark ventrikel kanan pada 30% pasien dengan sensitivitas, spesifisitas dan ketepatan prediksi masing-masing sebesar 67%, 88%, dan 73%. Gambaran ekokardiografi terdiri dari pembesaran ventrikel kanan dengan hipokinesia atau akinesia. Dilatasi dan disfungsi ventrikel kanan diperoleh dari besar relatif ventrikel kanan terhadap ventrikel kiri. Cara ini lebih sensitif dan spesifik dibandingkan gejala klinik dan EKG.

Impact of Right Ventricular Dysfunction in Morbidity and Mortality in Patients with Inferior Wall Myocardial Infarction Presenting to a Tertiary Care Center of Nepal

“…There was no statistically significant difference between groups with regard to baseline variables like age, sex, obesity, body mass index (BMI), type 2 diabetes mellitus, hypertension, smoking and family history. This finding was akin to a study done by Pandey et al [33] The AV block prevalence was higher in patients who had RV involvement. World Journal of Cardiovascular Diseases Only 5.5% of patients without RV involvement had second-or third-degree AV Block while 32% of patients with RV involvement had second-or third-degree AV block (p < 0.001).…”

“…Various studies have shown 20% -50% incidence of RVMI in IWMI. [32] In a study by Pandey et al, [33] 32% of patients with IWMI had an evidence of RVMI on echocardiography. There was no age difference between those with and without RV involvement.…”

Kussmaul’s sign for the diagnosis of right ventricular myocardial infarction: a systematic review and meta-analysis of diagnostic test accuracy studies

“…Ten were selected for full text review; their detailed characteristics are presented in Table 2. Eight of these ten studies were included in the statistical analysis [2,9,[16][17][18][19][20][21].…”

“…This finding is estimated to be 70-100% sensitive and 87-100% specific [2,7,8]. However, these changes are transient in nature and may be absent in up to half of patients with right ventricular myocardial infarction ten hours after the onset of chest pain [9].…”