Acute management of right ventricular infarction

Abstract

Right ventricular infarction is commonly seen in the presence of inferior ST-segment elevation myocardial infarction (STEMI) but its recognition and diagnosis is a clinical challenge. Right ventricular infarction has been described in up to 50% of patients with acute inferior STEMI with the majority of patients remaining asymptomatic and clinically stable. The classic triad used to describe the clinical manifestations is hypotension, raised jugular venous pressure and clear lung fields on auscultation. A right-sided ECG demonstrating 1 mm ST elevation in V4R, which is transient, confirms suspicion of RVI. Treatment goals include prompt reperfusion, avoidance of medications that reduce preload, volume loading with the option of adding inotropic support or insertion of an intra aortic balloon pump. Prognosis is positive with the majority of patients recovering baseline right ventricular function in the months following the event. Clinical consequences of RVI include hypotension, bradycardia, conduction disturbances and depressed right ventricular function if not recognized promptly. Emergency and cardiovascular nurses have a pivotal role in the identification, assessment and treatment of these patients as they are commonly the first point of medical contact.