Management and prognostic of right ventricular extended myocardial infarction: About a Moroccan experience

Abstract

Myocardial infarction can affect any myocardial territory, however, the isolated right ventricle infarction is exceptional. It is often biventricular with a high mortality of about 30% compared to that of isolated LV (6%). Assess the prevalence of acute myocardial infarction extended to RV, and study the epidemiological, clinical, diagnostic, therapeutic and prognostic. Retrospective and descriptive study conducted in the Cardiology department in CHU Ibn-Rochd in Casablanca. It was conducted on patients admitted in ICU for acute MI extended to the RV, in the period January 2016 to June 2018. Of the 360 patients, who suffered a myocardial infarction in acute phase, 22 patients (6% of all AMI, 23% inferior MI) had an acute MI extended to RV. The average age of our patients was 61 years ranging from 53 to 70 years, with a male predominance. The majority of our patients (81%) have more than 03 cardiovascular risk factors. Chest pain with in physical examination: the jugular turgor, hypotension and bradycardia were the most common clinical signs in our patients. The ECG showed an ST-elevation in right leads (V3R, V4R) and in the inferior territory (DII, DIII and AvF) in all our patients. Dilatation of right cavities and wall motion disorders were the most frequent echocardiographic abnormalities (63% of patients). The most frequent complications were hemodynamic instability (46%) and rhythmic complications (36%). From the therapeutic point, thrombolysis was performed in 18 patients, which 6 patients received an additional angioplasty after failed thrombolysis. Ten patients required vascular filling, and inotropic drugs were used in 4 of our patients. Mortality in our series was 10%. Our series underscores the value of nearly management of patients admitted to the acute phase of MI extended to RV, and the considerable contribution of thrombolysis as a means of revascularization and its positive impact on prognosis.