Difficulties in diagnosis of infarction of the right ventricular myocardium
Fomina, I.G.; Bubnova, I.A.; D'iakova, T.A.
Klinicheskaia Meditsina 80(3): 7-13
2002
ISSN/ISBN: 0023-2149 PMID: 11980166 Document Number: 542497
About half of the patients with symptoms of inferior acute myocardial infarction (MI) of the left ventricle (LV) are found to have proximal occlusion of the dominant right coronary artery presented on ECG by ischemia or infarction of the right ventricular wall. Hypotension, high pressure in the jugular veins and, in some cases, shock with clear lung fields--typical clinical picture of right ventricular MI. The diagnosis begins with ECG picture of LV lower wall ischemia (rise of ST wave in leads II, III and aVF) with possible emergence of a pathological wave Q and right ventricular ischemia (rise of ST wave in leads V3R-V6R and its depression in leads V2-V4). Echo-CG and balanced radioventriculography were used for verification of the diagnosis, precise localization of the myocardial lesion. Therapy of patients with right ventricular MI consists in maintenance of adequite preload of the right ventricle, inotropic support and control over atrioventricular conduction.