The electrocardiogram in right ventricular myocardial infarction

Abstract

Right ventricular (RV) myocardial infarction most often occurs in the setting of inferior wall myocardial infarction. Right ventricular infarction complicates approximately 25% (range, 20%-60%) of inferior acute myocardial infarction; it is uncommon to quite rare in anterior and lateral wall acute myocardial infarction. With infarction of the RV, the RV will fail. As such, left ventricular filling pressures are entirely dependent upon the patient's preload; with significant reductions in the preload, hypotension likely results (this hypotension may be worsened by nitroglycerin and morphine). The clinical presentation, in the setting of an ST-elevation myocardial infarction (STEMI) of the inferior wall, involves hypotension, jugular venous distension, and the following electrocardiographic findings: ST-segment elevation of greatest magnitude in lead III (compared with leads II and aVF), ST-segment elevation in lead V 1, and/or ST-segment elevation in right chest leads (RV 1 through RV 6). Therapy, in addition to appropriate management for STEMI, relies largely on enhancing the preload with intravenous fluid and judicious use of vasodilator medications. Patients with inferior wall STEMI with RV infarction have a markedly worse prognosis (both acute cardiovascular complications and death) compared with patients with isolated inferior wall STEMI.