Right Ventricular Myocardial Infarctions

Acute isolated right ventricular (RV) myocardial infarctions are relatively uncommon in clinical practice; more frequently, RV infarctions occur in association with inferior ST-segment elevation myocardial infarctions. Recent advances in diagnostic tools and methods have significantly improved our ability to detect RV infarctions in both scenarios. For this reason, it is critical for physicians to understand the pathophysiology, clinical presentation, and diagnostic criteria for RV infarctions to initiate treatment and optimize the outcomes of patients. About half of all patients with an inferior ST-segment elevation myocardial infarction develop RV infarction. In the acute setting, RV infarctions can lead to hemodynamic instability and frank shock, which are responsible for the high morbidity and mortality associated with these episodes. However, when treated properly, the prognosis of RV myocardial infarctions is quite excellent if the patient survives the acute hemodynamic compromise. In addition, RV infarctions are likely a misnomer since these events tend to represent ischemia and stunning of the RV myocardium that results in its short-term dysfunction, but the myocardium remains viable and recovers over time with no signs of an infarct if the patient survives the episode. In fact, patient outcomes in RV ischemia are dependent more on the involvement of the left ventricle than RV involvement, especially since a left ventricular infarct and dysfunction can be difficult to overcome in the long term. It is imperative to understand the various treatments available to target the hemodynamic changes and shock often seen in patients with acute RV ischemia and to implement these treatments accordingly to improve patient survival and prognosis.