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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
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Right Ventricular Infarction and ECG Findings
Introduction
Right ventricular infarction (RVI) is a condition where the right ventricle of the heart suffers from ischemia due to an obstruction in the right coronary artery. It often occurs in conjunction with an inferior myocardial infarction (MI) and has distinct clinical and electrocardiographic (ECG) findings.
Importance of Recognizing Right Ventricular Infarction
- Higher Mortality and Complications: RVI is associated with hypotension, arrhythmias, and an increased risk of cardiogenic shock.
- Different Management Approach: IV fluids and preload-dependent support are crucial, whereas excessive use of vasodilators (e.g., nitroglycerin) can be harmful.
ECG Findings of Right Ventricular Infarction
1. Inferior Myocardial Infarction (IMI) Presence
Since RVI frequently accompanies IMI, look for ST-segment elevations in Leads II, III, and aVF.
2. Right-Sided Leads (V3R–V6R)
- The most specific sign of RVI is ST-segment elevation in lead V4R
- Leads V3R-V6R can show ST-elevation >1 mm, confirming right ventricle involvement
3. Lead III > Lead II ST Elevation
- Greater ST-segment elevation in Lead III than in Lead II suggests right coronary artery involvement
4. Absence of Reciprocal ST Depression in Lead I
- Unlike left-sided infarcts, the absence of ST depression in Lead I strengthens suspicion of RVI
5. Bradyarrhythmias and AV Blocks
- High-degree atrioventricular (AV) block and sinus bradycardia are common in RVI
Management of Right Ventricular Myocardial Infarction
- Volume Expansion: IV fluids to maintain venous return
- Avoid Nitrates and Diuretics: These can reduce preload and worsen hypotension
- Inotropic Support if Needed: Dopamine or dobutamine if hypotension persists
- Reperfusion Therapy: PCI or fibrinolysis as per STEMI guidelines
Conclusion
Recognizing right ventricular infarction through ECG is crucial for guiding appropriate treatment. Early identification and targeted therapy can significantly improve outcomes.
Source recommendations
1. 2022 American College of Cardiology/American Heart Association Guideline for the Management of Patients With ST-Elevation Myocardial Infarction
- https://www.ahajournals.org/doi/10.1161/HCQ.0000000000000112
- https://www.sciencedirect.com/science/article/pii/S073510972106157X
- https://www.ahajournals.org/doi/10.1161/01.cir.0000134791.68010.fa
- https://pubmed.ncbi.nlm.nih.gov/10973852/
- https://www.jacc.org/doi/10.1016/j.jacc.2022.08.750
2. 2023 European Society of Cardiology Guidelines on Acute Coronary Syndromes
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
- https://academic.oup.com/eurheartj/article/44/38/3720/7243210
- https://pubmed.ncbi.nlm.nih.gov/37622654/
- https://journals.lww.com/cd/fulltext/2023/12000/what_is_new_in_the_2023_european_society_of.1.aspx
- https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/08/29/14/01/2023-esc-guidelines-acs-esc-2023
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
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