Myocardial Infarction of the Right Ventricle

Abstract

Right ventricular (RV) myocardial infarction (MI) usually occurs in the setting of an inferior MI (IMI) when the acute occlusion of the right coronary artery (RCA) is located proximally to the acute RV marginal branches, which commonly provide blood supply to the RV. RV MI may result in severe right heart failure with hemodynamic compromise and cardiogenic shock which distinctly differs from the cardiogenic shock secondary to left ventricular (LV) dysfunction, presenting with the clinical triad of low-output hypotension, clear lungs, and jugular venous distention despite intact global LV systolic function. The ECG provides further confirmation by examining the right precordial leads, V1 and more specifically V4R displaying ST elevation. Management of this type of cardiogenic shock is also grossly different from the management of LV shock requiring fluid resuscitation and/or vasopressors as the most important initial approach; however more definitive treatment is similar to any type of acute MI with prompt mechanical reperfusion therapy, most effectively achieved via primary percutaneous coronary intervention (PCI) of the culprit coronary artery occlusion.