Right Ventricular Dysfunction
Infarction of the right ventricle is normally associated with inferior infarction, but may occur in isolation. Patients present with hypotension and distended neck veins, but without signs of pulmonary oedema. This clinical picture in the setting of inferior infarction should prompt the recording of a right sided chest lead (V4R) which may confirm ST elevation.
What will echocardiography demonstrate at this stage?
Echocardiography demonstrates varying degrees of right ventricular myocardial wall dysfunction and/or functional tricuspid incompetence due to ventricular dilatation.
It is important to recognise hypotension due to right ventricular infarction because its management is significantly different to that for cardiogenic shock resulting from left ventricular dysfunction. In particular, it is vital to maintain right ventricular preload: the use of drugs that reduce preload (such as nitrates and opiates) can cause significant reductions in blood pressure. A fluid challenge is effective in maintaining venous return, and should be administered alongside careful haemodynamic monitoring. Rapid reperfusion is also necessary in order to improve the haemodynamic state.
Learning Bite
It is important to recognise right ventricular infarction because it has implications for management, e.g. Avoidance of nitrates, may require fluid challenge.