Clinical Outcome and Echocardiographic Evaluation of Inferior Myocardial Infarction with Right Ventricular Involvement.
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Date
2012
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Abstract
Background : Acute right ventricular myocardial infarction complicates inferior wall myocardial
infarction with an incidence of 14-84%. ECG is the cornerstone in initial diagnosis as it is cost
effective and done easily. Echocardiographic analysis of the right ventricular involvement can shed
light on the severity of the disease. Hence we aimed to study right ventricular infarction in acute
inferior wall myocardial infarction using right precordial lead as well as echocardiography.
Methods: Present study is based on the analysis of 100 patients admitted to Coronary care unit of the
National Institute of Cardiovascular Diseases & Hospital during July 2010 to June 2011, with acute
inferior wall myocardial infarction. 12 lead ECG with thorough physical examination was done
along with right precordial mapping. ST ³ 1mm in V4R was initial diagnostic of right ventricular
involvement followed by echocardiographic assessment of RV and LV within 24 hours.
Results: A total of 50 patients showed right ventricular involvement with V4R being the sensitive
lead. Echocardiography showed mean RVEF of patients with 29.5 % ± 9.5 in comparison of
44.9%±12.2 without right ventricular involvement. Right ventricular involvement presented with
bradycardia (40%) and hypotension, 80% Kussmaul’s sign, 14% with complete heart block. Mortality
in right ventricular involvement was 6 times higher than without right ventricular involvement
(12 %).
Conclusion: Clinical signs and symptomatology are not fully diagnostic of RVI in inferior wall
acute MI. ECG can diagnose (using right precordial mapping) this condition very early.
Echocardiography help to assess the right ventricular function high-risk groups for aggressive
management like primary PCI. Early diagnosis will help in careful monitoring and management of
such cases.
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Keywords
Electrocardiography,, Echocardiography, Right ventricular infarction, Acute myocardial infarction
Citation
Guha B, Majumder A A S, Chowdhury M N A, Hossain M M, Mandal A K. Clinical Outcome and Echocardiographic Evaluation of Inferior Myocardial Infarction with Right Ventricular Involvement. Cardiovascular Journal. 2012; 4(2): 132-138.