Right ventricular myocardial infarction

Severe right ventricular (RV) dysfunction leading to the classic hemodynamic changes occurs in approximately 10% of inferior myocardial infarctions and is associated with higher rates of mortality, cardiogenic shock, sustained ventricular arrhythmias, and advanced atrioventricular (AV) block. The RV is pyramidal shaped with a triangular base and a thin crescentic free wall. The diagnosis of RV myocardial infarction is made using the clinical presentation in combination with echocardiogram (ECG), echocardiographic, and/or hemodynamic criteria. Abrupt RV dilatation within a noncompliant pericardium leads to elevated intrapericardial pressure. RV infarction is characterized by increased RA and RV diastolic pressures, low cardiac output, and systolic hypotension. LV dysfunction (e.g., inferior myocardial infarction) increases RV afterload, which can further reduce cardiac output. Management of RV infarction can be summarized as follows: early recognition+reperfusion+volume expansion±dobutamine. Once RV preload is optimized, dobutamine may improve RV function and cardiac output.