Case Of Right Ventricular Infarction Research Articles

症例 脱水を合併し,興味深い血行動態所見を示した右室梗塞の1例

症例 脱水を合併し,興味深い血行動態所見を示した右室梗塞の1例

Contrast-enhanced magnetic resonance imaging guided decision making after primary percutaneous coronary intervention for acute ST-elevation inferior myocardial infarction

Coronary occlusion of large epicardial branches leads to profound ischemia at the infarct core, resulting in simultaneous necrosis of myocytes and endothelial cells. This process leads to microvascular obstruction in the infarct core, described as the no-reflow region in basic studies and documented in humans by contrast-enhanced magnetic resonance imaging and ultrasound. After coronary occlusion, contrast-enhanced magnetic resonance identifies myocardial infarction as a hyperenhanced region containing a hypoenhanced core. There is growing interest in incorporating its assessment into the evaluation of acute myocardial infarction because it is the key in defining specific therapeutic strategies and in directing the interventional therapy. We report a rare case of right ventricular infarction where contrast-enhanced magnetic resonance produced detailed images of myocardial perfusion pattern and tissue damage and directed the treatment after acute myocardial infarction.

Casuística de los infartos de cara inferior extendidos a ventrículo derecho en el hospital San Marcos de Chinchiná durante los años 2001-2004

Introducción. El infarto del ventrículo derecho es una complicación grave del infarto de cara inferior el cual es a su vez causado por oclusión proximal de la arteria coronaria derecha. Sin embargo, la extensión al ventrículo derecho es poco frecuente y los hallazgos patológicos que permitan explicar esta situación son aún inciertos.Objetivo. Analizar todos los casos de infarto de cara inferior extendido al ventrículo derecho ocurrido en el Hospital San Marcos de Chinchiná durante el período de 2001- 2004 y sus factores de riesgo como predictores de complicación.Métodos. Se estudiaron todos los pacientes atendidos por dolor precordial en el servicio de Urgencias del Hospital San Marcos de Chinchiná en un período de 4 años. Se valoró la asociación entre este evento coronario y muchos factores de riesgo conocidos de tiempo atrás tales como el hábito de fumar, la hipertensión arterial, la edad avanzada, el sexo masculino y la hipercolesterolemia.Resultados. De los 53 pacientes admitidos inicialmente con un diagnóstico inicial de infarto agudo de miocardio, a once de ellos se les confirmó Infarto de cara inferior. 42 pacientes fueron excluidos debido a que no cumplían los criterios de inclusión. Solo 3 pacientes de los once tuvieron compromiso del ventrículo derecho. El diagnóstico fuehecho principalmente con elementos clínicos ya que no había reportes de toma de precordiales derecha en la gran mayoría de los casos. Se encontraron diferencias significativas en edad, género, factores de riesgo cardiovasculares en pacientes con la extensión del infarto al ventrículo derecho.

Right ventricular infarction following percutaneous coronary rotational atherectomy

We describe a case of right ventricular infarction complicating percutaneous coronary rotational atherectomy of sequential calcified right coronary artery lesions. Right ventricular infarction resulted from occlusion of two right ventricular marginal branches during successful atherectomy of the right coronary artery.

Right Atrial and Ventricular Infarction

In order to compare the results of transesophageal echocardiography (TEE) in diagnosis of right atrial (RA) and right ventricular (RV) infarction with those of transthoracic echocardiography (TTE), 11 patients admitted to the coronary care unit with the diagnosis of posteroinferior left ventricular (LV) acute myocardial infarction (MI) and electrocardiographic suspicion of extension to RV were studied. In two of the 11 patients, RA infarction was identified on the basis of akinesis of the RA free wall, dilatation of the atrial cavity, spontaneous echo contrast, mural thrombosis, and poor atrial contribution to RV filling. In all 11 patients, RV infarction was determined by akinesis of one or more segmental regions, dilatation of the cavity in four patients, and tricuspid regurgitation in seven. Only six cases of RV infarction were diagnosed with TTE. The findings indicate that TEE provides additional information to TTE for determining RA and RV infarction during the early stages of MI.

Effect of intra-aortic balloon counterpulsation on right-left shunt following right ventricular infarction

Intra-aortic balloon counterpulsations decrease the left ventricular end-diastolic pressure and, subsequently, the left atrial pressure in patients with impaired myocardial function following myocardial infarction. This paper reports a case of right ventricular infarction in a patient with patency of the oval foramen where the use of intra-aortic balloon counterpulsation led to the perpetuation of the right-to-left shunt.

Masking of electrocardiographic features of right ventricular infarction by true posterior left ventricular infarction

An echocardiographically documented case of right ventricular infarction is reported. Electrocardiographic diagnosis was masked by concomitant true posterior left ventricular infarction. This case highlights an important limitation of electrocardiography in diagnosing right ventricular infarction.

A case of right ventricular infarction rapidly improved both electrocardiographically and hemodynamically after direct percutaneous transluminal coronary angioplasty

A case of right ventricular infarction rapidly improved both electrocardiographically and hemodynamically after direct percutaneous transluminal coronary angioplasty

Massive ST-segment elevation in precordial and inferior leads in right ventricular myocardial infarction

This report describes a case of right ventricular infarction in which massive ST-segment elevation in the precordial and inferior leads was observed. The maximum magnitude of the ST-segment elevation in the precordial leads was 21 mm in lead V2 and that in the inferior leads was 10 mm in lead II. Angiography revealed a reduction of 90% in the diameter of the right coronary artery in its proximal portion and a normal left coronary system. Recent reports have shown that precordial ST-segment elevation may reflect right ventricular infarction. However, no previously reported instance except our case has shown massive ST-segment elevation in both the precordial and inferior leads. In right ventricular infarction, the current of injury is usually simultaneously present in the right ventricular free wall and left ventricular inferior wall, electrically opposed to each other. Thus, the diffuse and massive ST-segment elevation observed in this study seems to be a rare phenomenon.

A case of right ventricular infarction effectively treated by intracoronary thrombolysis

A case of right ventricular infarction effectively treated by intracoronary thrombolysis

ST elevations in leads V 1 to V 5 may be caused by right coronary artery occlusion and acute right ventricular infarction

In 5 of 69 patients (7%) undergoing intracoronary or intravenous streptokinase treatment, the ST-segment elevations in leads V1 to V5 were caused by occlusion of the right rather than the left anterior descending coronary artery and by myocardial infarction (MI) of the right ventricular (RV) wall rather than the anterior left ventricular (LV) wall or the ventricular septum. RV involvement was documented by technetium pyrophosphate uptake, hypokinesia, dilatation and depressed RV ejection fraction. The left anterior descending artery was patent and the anterior LV wall had normal thallium-201 uptake, no technetium uptake and normal wall motion. ST-segment elevation was highest in lead V1 or V2 and decreased toward lead V5; in patients with anterior LV MI, the ST-segment elevations are usually lowest in lead V1 and increase toward the V5 lead. In contrast to anterior LV infarcts, the R waves in leads V1 to V5 did not decrease and Q waves did not evolve with progression of the MI. The ST-segment elevations in leads V1 to V5 in our patients were associated with small or absent ST-segment elevations in leads, II, III and aVF, suggesting that in other cases of RV infarction, the appearance of ST-segment elevations in leads V1 to V5 is blocked by the dominant electrical forces of the LV inferior MI. This suggestion was confirmed in a canine model. Recognition of the presence of RV infarction may be therapeutically important.

Right ventricular infarction complicated by right to left shunt

A case of right ventricular infarction complicated by a right to left shunt through a patent foramen ovale is presented. The diagnosis was confirmed by two-dimensional echocardiography with contrast injection and indicator dye-dilution curve and oximetry at cardiac catheterization.