The challenges in the management of right ventricular infarction

In recent years, right ventricular (RV) infarction seems to be underdiagnosed in most cases of acute myocardial ischaemia despite its frequent association with inferior-wall and, occasionally, anterior-wall myocardial infarction (MI). However, its initial management is drastically different from that of left ventricular MI, and studies have indicated that RV infarction remains associated with significant morbidity and mortality, even in the mechanical reperfusion era. The pathophysiology of RV infarction involves the interaction between the right and left ventricle (LV), and the mechanism has been clarified with the advent of diagnostic non-invasive modalities, such as echocardiography and cardiac magnetic resonance. In recent years, considerable progress has been made in the treatment of RV infarction; early revascularization remains the cornerstone of the management, and fluid resuscitation, with appropriate target selection, is necessary to maintain appropriate preload. Early recognition in intensive care with clear understanding of the pathophysiology is essential to improve its prognosis. In terms of management, the support strategy for RV dysfunction is different from that for LV dysfunction since the former may often be temporary. Along with early reperfusion, maintenance of an adequate heart rate and atrioventricular synchrony are essential to sustain a sufficient cardiac output in patients with RV infarction. In refractory cases, more intensive mechanical support is required, and new therapeutic options, such as Tandem-Heart or percutaneous cardiopulmonary support systems, are being developed.

[1]  Nishant R. Shah,et al.  Percutaneous Circulatory Support in Cardiogenic Shock: Interventional Bridge to Recovery , 2012, Circulation.

[2]  J. Hoffmann,et al.  Right Ventricular Injury in ST-Elevation Myocardial Infarction: Risk Stratification by Visualization of Wall Motion, Edema, and Delayed-Enhancement Cardiac Magnetic Resonance , 2012, Circulation. Cardiovascular imaging.

[3]  James O. Mudd,et al.  Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure. , 2011, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[4]  A. Shah,et al.  Multivessel intervention and placement of a percutaneous right ventricular assist device in a patient with acute myocardial infarction complicated by cardiac arrest. , 2011, The Journal of invasive cardiology.

[5]  C. Catalano,et al.  Right Ventricular Ischemic Injury in Patients With Acute ST-Segment Elevation Myocardial Infarction: Characterization With Cardiovascular Magnetic Resonance , 2010, Circulation.

[6]  J. Kasprzak,et al.  Right Ventricular Function Suffers From Reperfusion Delay: Tissue Doppler Study , 2010, Clinical cardiology.

[7]  P. Hunold,et al.  Right ventricular involvement in acute left ventricular myocardial infarction: prognostic implications of MRI findings. , 2010, AJR. American journal of roentgenology.

[8]  N. Kapur,et al.  Percutaneous right ventricular assist via the internal jugular vein in cardiogenic shock complicating an acute inferior myocardial infarction. , 2010, The Journal of invasive cardiology.

[9]  J. Goldstein,et al.  Malignant ventricular arrhythmias in patients with acute right ventricular infarction undergoing mechanical reperfusion. , 2009, The American journal of cardiology.

[10]  S. Walsh,et al.  In-hospital percutaneous coronary intervention improves in-hospital survival in patients with acute inferior myocardial infarction particularly with right ventricular involvement. , 2009, The Journal of invasive cardiology.

[11]  M. Hamon,et al.  Prognostic impact of right ventricular involvement in patients with acute myocardial infarction: Meta-analysis , 2008, Critical care medicine.

[12]  J. Prutkin,et al.  Percutaneous right ventricular assist device as support for cardiogenic shock due to right ventricular infarction. , 2008, The Journal of invasive cardiology.

[13]  M. Strudwick,et al.  Reproducibility of right ventricular volumes and ejection fraction using real-time three-dimensional echocardiography: comparison with cardiac MRI. , 2007, Chest.

[14]  R. Kornowski,et al.  Prognostic importance of right ventricular infarction in an acute myocardial infarction cohort referred for contemporary percutaneous reperfusion therapy. , 2007, American heart journal.

[15]  C. Rihal,et al.  Long-term survival after right ventricular infarction. , 2006, The American journal of cardiology.

[16]  J. Schulz-Menger,et al.  Contrast-enhanced cardiovascular magnetic resonance imaging of right ventricular infarction. , 2006, Journal of the American College of Cardiology.

[17]  W. O’Neill,et al.  Impact of mechanical reperfusion on clinical outcome in elderly patients with right ventricular infarction , 2006, Coronary artery disease.

[18]  R. Smalling,et al.  Initial report of percutaneous right ventricular assist for right ventricular shock secondary to right ventricular infarction , 2006, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[19]  S. Sprovieri,et al.  Impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular infarction. , 2006, Sao Paulo medical journal = Revista paulista de medicina.

[20]  A. Heldman,et al.  Resuscitation and recovery from acute right ventricular failure using a percutaneous right ventricular assist device , 2006, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[21]  H. White,et al.  Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. , 2006, JAMA.

[22]  D. Dudek,et al.  Inferior wall myocardial infarction with or without right ventricular involvement--treatment and in-hospital course. , 2006, Kardiologia polska.

[23]  L. Tavazzi,et al.  Right ventricular functional recovery after acute myocardial infarction: relation with left ventricular function and interventricular septum motion. GISSI-3 echo substudy , 2005, Heart.

[24]  G. Lamas,et al.  ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients wi , 2004, Journal of the American College of Cardiology.

[25]  S. Sharieff,et al.  Prevalence of right ventricular myocardial infarction in patients with acute inferior wall myocardial infarction , 2004, International journal of clinical practice.

[26]  Saraiva Lr,et al.  Acute myocardial infarction: predictors of mortality at a public hospital in the city of Fortaleza, Ceará state , 2003 .

[27]  J. Boura,et al.  Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction : a quantitative review of 23 randomised trials , 2022 .

[28]  L. Saraiva,et al.  Acute myocardial infarction: predictors of mortality at a public hospital in the city of Fortaleza, Ceará state. , 2003, Arquivos brasileiros de cardiologia.

[29]  K. Harjai,et al.  Comparison of effectiveness of primary angioplasty for proximal versus distal right coronary artery culprit lesion during acute myocardial infarction. , 2002, The American journal of cardiology.

[30]  J. Goldstein Pathophysiology and management of right heart ischemia. , 2002, Journal of the American College of Cardiology.

[31]  Lemuel A Moyé,et al.  Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. , 2002, Journal of the American College of Cardiology.

[32]  J. Spinelli,et al.  Value of ST elevation in lead III greater than lead II in inferior wall acute myocardial infarction for predicting in-hospital mortality and diagnosing right ventricular infarction. , 2001, The American journal of cardiology.

[33]  S. Yusuf,et al.  Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction. , 2001, Journal of the American College of Cardiology.

[34]  H. Katus,et al.  Clinical and angiographic outcome of patients with acute inferior myocardial infarction , 2000, Zeitschrift für Kardiologie.

[35]  L. Horan,et al.  Right ventricular infarction: specific requirements of management. , 1999, American family physician.

[36]  A. Nogami,et al.  Right ventricular infarction with cardiogenic shock treated with percutaneous cardiopulmonary support: a case report. , 1999, Japanese circulation journal.

[37]  CarlBrookes,et al.  Acute Right Ventricular Dilatation in Response to Ischemia Significantly Impairs Left Ventricular Systolic Performance , 1999 .

[38]  K. Wegscheider,et al.  Effects of thrombolytic therapy in acute inferior myocardial infarction with or without right ventricular involvement. HIT-4 Trial Group. Hirudin for Improvement of Thrombolysis. , 1998, Journal of the American College of Cardiology.

[39]  J. Goldstein Right heart ischemia: pathophysiology, natural history, and clinical management. , 1998, Progress in cardiovascular diseases.

[40]  P. Bonoris,et al.  Volume loading in predominant right ventricular infarction: bedside haemodynamics using rapid response thermistors. , 1994, European heart journal.

[41]  J. Goldstein,et al.  Effects of Reperfusion on Ischemic Right Ventricular Dysfunction: Disparate Mechanisms of Benefit Related to Duration of Ischemia , 1994, Circulation.

[42]  A. Mussini,et al.  Hemodynamics of volume loading compared with dobutamine in severe right ventricular infarction. , 1994, The American journal of cardiology.

[43]  J. W. Kinch,et al.  Right ventricular infarction. , 1994, The New England journal of medicine.

[44]  A. Jacobs,et al.  Frequency and significance of right ventricular dysfunction during inferior wall left ventricular myocardial infarction treated with thrombolytic therapy (results from the Thrombolysis in Myocardial Infarction [TIMI] II trial) , 1993 .

[45]  J. Bengtson,et al.  Isolated Right Ventricular Myocardial Infarction , 1993, Annals of Internal Medicine.

[46]  M. Olschewski,et al.  Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. , 1993, The New England journal of medicine.

[47]  A. Jacobs,et al.  Frequency and significance of right ventricular dysfunction during inferior wall left ventricular myocardial infarction treated with thrombolytic therapy (results from the thrombolysis in myocardial infarction [TIMI] II trial). The TIMI Research Group. , 1993, The American journal of cardiology.

[48]  A. Jaffe,et al.  Importance of left ventricular function and systolic ventricular interaction to right ventricular performance during acute right heart ischemia. , 1992, Journal of the American College of Cardiology.

[49]  F. A. Lee,et al.  Hemodynamics of the right ventricle in normal and disease states. , 1992, Cardiology clinics.

[50]  A. Jaffe,et al.  Right atrial ischemia exacerbates hemodynamic compromise associated with experimental right ventricular dysfunction. , 1991, Journal of the American College of Cardiology.

[51]  J. Dhainaut,et al.  Role of tricuspid regurgitation and left ventricular damage in the treatment of right ventricular infarction-induced low cardiac output syndrome. , 1990, The American journal of cardiology.

[52]  A. Jaffe,et al.  Determinants of hemodynamic compromise with severe right ventricular infarction. , 1990, Circulation.

[53]  A. Kastrati,et al.  Optimal value of filling pressure in the right side of the heart in acute right ventricular infarction. , 1990, British heart journal.

[54]  J. Lancaster,et al.  Hemodynamically important right ventricular infarction: follow-up evaluation of right ventricular systolic function at rest and during exercise with radionuclide ventriculography and respiratory gas exchange. , 1987, Circulation.

[55]  H. Rasmussen,et al.  Value of two-dimensional echocardiography, electrocardiography, and clinical signs in detecting right ventricular infarction. , 1986, American heart journal.

[56]  D. Berman,et al.  Scintigraphically detected predominant right ventricular dysfunction in acute myocardial infarction: clinical and hemodynamic correlates and implications for therapy and prognosis. , 1985, Journal of the American College of Cardiology.

[57]  R. O'rourke,et al.  Comparative effects of volume loading, dobutamine, and nitroprusside in patients with predominant right ventricular infarction. , 1985, Circulation.

[58]  R. O'rourke,et al.  Right ventricular infarction: identification by hemodynamic measurements before and after volume loading and correlation with noninvasive techniques. , 1984, Journal of the American College of Cardiology.

[59]  J. Alpert,et al.  Reversibility of hypotension and shock by atrial or atrioventricular sequential pacing in patients with right ventricular infarction. , 1984, American heart journal.

[60]  E. R. Smith,et al.  Effects of diastolic transseptal pressure gradient on ventricular septal position and motion. , 1983, Circulation.

[61]  R. O'rourke,et al.  Physical examination for exclusion of hemodynamically important right ventricular infarction. , 1983, Annals of internal medicine.

[62]  J. Tyberg,et al.  Volume loading improves low cardiac output in experimental right ventricular infarction. , 1983, Journal of the American College of Cardiology.

[63]  P. Mclaughlin,et al.  The spectrum of right ventricular involvement in inferior wall myocardial infarction: a clinical, hemodynamic and noninvasive study. , 1983, Journal of the American College of Cardiology.

[64]  P. Brugada,et al.  Value of electrocardiogram in diagnosing right ventricular involvement in patients with an acute inferior wall myocardial infarction. , 1983, British heart journal.

[65]  R. Asinger,et al.  Functional consequences of interventricular septal involvement in right ventricular infarction: echocardiographic, clinical, and hemodynamic observations. , 1983, American heart journal.

[66]  E. Kaplinsky,et al.  The Early Recognition of Right Ventricular Infarction: Diagnostic Accuracy of the Electrocardiographic V 4R Lead , 1983, Circulation.

[67]  J. López-Sendón,et al.  Volume loading in patients with ischemic right ventricular dysfunction. , 1981, European heart journal.

[68]  N. Fowler,et al.  Electrocardiographic diagnosis of right ventricular infarction. , 1981, The American journal of medicine.

[69]  J. Cinca,et al.  Right ventricular infarction: relationships between ST segment elevation in V4R and hemodynamic, scintigraphic, and echocardiographic findings in patients with acute inferior myocardial infarction. , 1981, American heart journal.

[70]  J. Aranda,et al.  Bedside recognition, incidence and clinical course of right ventricular infarction. , 1981, The American journal of cardiology.

[71]  W. Roberts,et al.  Right ventricular infarction complicating left ventricular infarction secondary to coronary heart disease. Frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. , 1978, The American journal of cardiology.

[72]  D. Durrer,et al.  Prevalence of right ventricular involvement in inferior wall infarction assessed with myocardial imaging with thallium-201 and technetium-99m pyrophosphate. , 1978, The American journal of cardiology.

[73]  B. Massie,et al.  The Noninvasive Diagnosis of Right Ventricular Infarction , 1978, Circulation.

[74]  D. Fixler,et al.  Hemodynamic alterations during septal or right ventricular ischemia in dogs. , 1977, American heart journal.

[75]  L. Erhardt,et al.  Single right-sided precordial lead in the diagnosis of right ventricular involvement in inferior myocardial infarction. , 1976, American heart journal.

[76]  M. Weisfeldt,et al.  Right Ventricular Dysfunction Detected by Gated Scintiphotography in Patients with Acute Inferior Myocardial Infarction , 1975, Circulation.