About-Cardio
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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.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Right Ventricular Myocardial Infarction (RVMI) and ECG Diagnosis
Introduction
Right Ventricular Myocardial Infarction (RVMI) is a condition in which the right ventricle of the heart is affected by an ischemic event, often accompanying an inferior wall myocardial infarction (IWMI). Early diagnosis is crucial, as RVMI can lead to significant hemodynamic instability.
ECG Findings in RVMI
Key ECG Changes:
- ST-segment elevation in right precordial leads (V3R–V6R): The hallmark of RVMI is the presence of ST-segment elevation in the right-sided leads, especially V4R.
- Inferior wall involvement: Since RVMI is often seen with IWMI, ST-elevation is usually present in leads II, III, and aVF.
- ST elevation in lead III > lead II: This suggests right ventricular involvement.
- Reciprocal ST-segment depression in leads I and aVL: Helps differentiate RVMI from other infarct patterns.
- Absence of significant ST-elevation in V1-V2 (unless there is septal involvement).
Clinical Clues Supporting RVMI
- Hypotension with clear lungs: Left ventricular infarction often causes pulmonary congestion, but RVMI presents with hypotension without pulmonary edema due to reduced right ventricular output.
- Kussmaul's sign: Increased jugular venous pressure (JVP) with inspiration.
- Bradycardia or conduction blocks: Due to ischemia affecting the AV node.
Confirmatory Tests & Management
- Perform a right-sided ECG if RVMI is suspected.
- Fluids: These patients are preload-dependent, so cautious volume expansion is often needed.
- Avoid nitrates and diuretics, which can reduce preload and worsen hypotension.
- Consider inotropes (e.g., dobutamine) in severe cases.
Conclusion
Early recognition of RVMI using ECG is crucial for appropriate management. Right-sided ECG leads, hemodynamic assessment, and careful volume resuscitation can help improve outcomes.
Source recommendations
1. American Heart Association Guidelines on ST-Elevation Myocardial Infarction (STEMI)
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309
- https://professional.heart.org/en/science-news/2021-acc-aha-scai-guideline-for-coronary-artery-revascularization
- https://www.ahajournals.org/doi/10.1161/01.cir.0000134791.68010.fa
- https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack
- https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6
2. European Society of Cardiology Guidelines for the Management of 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://academic.oup.com/eurheartj/article/42/14/1289/5898842
- https://pubmed.ncbi.nlm.nih.gov/21873419/
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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.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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