Right ventricular myocardial infarction: A Review of 17 Cases

Right ventricular myocardial infarction (RVMI) is a rare but significant complication of inferior myocardial infarction (IMI), characterized by a sudden decrease in right ventricular function, which can lead to hemodynamic instability. This can range from mild dysfunction to severe hypotension, cardiogenic shock, and sudden cardiac death. RVMI is most often linked to occlusion of the right coronary artery (RCA), though it can also occur in the case of proximal left anterior descending (LAD) artery occlusion, particularly in large anterior infarctions.

Diagnosis can be challenging, as the electrocardiographic changes may be subtle or transient. The 12-lead ECG is the primary diagnostic tool, with right precordial leads (V3R and V4R) helping to improve sensitivity. Echocardiography, especially Doppler imaging, plays a crucial role in assessing right ventricular function and detecting complications like pericardial effusion and tricuspid regurgitation.

Treatment involves dual antiplatelet therapy, anticoagulation, and statins, with early reperfusion (thrombolysis or primary PCI) being key to improving outcomes. Volume resuscitation through intravenous fluids helps stabilize patients by ensuring adequate right ventricular preload.

The prognosis of RVMI depends on the severity of dysfunction, timely intervention, and the presence of complications. If treated promptly, patients can have favorable long-term outcomes, although delayed treatment or severe hemodynamic instability can lead to higher mortality. Further studies are needed to optimize management and understand long-term outcomes, particularly in patients with extensive infarctions or comorbidities.

Objective: The objective of the study is to describe the epidemiological, clinical, electrocardiographic, echocardiographic, and angiographic characteristics of myocardial infarction with right ventricular involvement, as well as its complications and therapeutic modalities.