Clinical Profile and In-Hospital Outcome of Patients with Right Ventricular Myocardial Infarction
Affiliation(s)
Department of Cardiology, Medical College, Kottayam, India. Department of Pharmacology, Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology Campus, Changa, India. Department of Clinical Trials, Sahajanand Medical Tech. Pvt. Ltd., Surat, India.
Department of Cardiology, Medical College, Kottayam, India. Department of Pharmacology, Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology Campus, Changa, India. Department of Clinical Trials, Sahajanand Medical Tech. Pvt. Ltd., Surat, India.
ABSTRACT
Objectives: Right ventricular myocardial infarction as assessed by various diagnostic methods accompanies inferior wall myocardial infarction in 30% to 50% of patients. Acute right ventricular myocardial infarction is associated with higher in-hospital morbidity and mortality related to life-threatening hemodynamic compromise and arrhythmias. Since there is scarcity of literature regarding epidemiology of clinical profile as well as in-hospital outcomes of patients with right ventricular myocardial infarction in the Indian population, this study is carried out with a goal of identifying the same in our hospital setting, to fulfill this void. Methods: We examined the incidence of risk factors in patients (n = 100) with inferior wall myocardial infarction and 100 patients with inferior wall myocardial infarction having right ventricular involvement. Results: The mortality rate was found to be 12% in patients with inferior wall myocardial infarction and 28% in patients having right ventricular involvement in inferior wall myocardial infarction. Conclusions: From the above study, it can be concluded that patients with inferior wall myocardial infarction who have right ventricular myocardial involvement are at an increased risk of death, and cardiogenic shock.
Objectives: Right ventricular myocardial infarction as assessed by various diagnostic methods accompanies inferior wall myocardial infarction in 30% to 50% of patients. Acute right ventricular myocardial infarction is associated with higher in-hospital morbidity and mortality related to life-threatening hemodynamic compromise and arrhythmias. Since there is scarcity of literature regarding epidemiology of clinical profile as well as in-hospital outcomes of patients with right ventricular myocardial infarction in the Indian population, this study is carried out with a goal of identifying the same in our hospital setting, to fulfill this void. Methods: We examined the incidence of risk factors in patients (n = 100) with inferior wall myocardial infarction and 100 patients with inferior wall myocardial infarction having right ventricular involvement. Results: The mortality rate was found to be 12% in patients with inferior wall myocardial infarction and 28% in patients having right ventricular involvement in inferior wall myocardial infarction. Conclusions: From the above study, it can be concluded that patients with inferior wall myocardial infarction who have right ventricular myocardial involvement are at an increased risk of death, and cardiogenic shock.
KEYWORDS
Inferior Wall Myocardial Infarction, Right Ventricular Myocardial Infarction, Epidemiology, Clinical Profile, Mortality
Inferior Wall Myocardial Infarction, Right Ventricular Myocardial Infarction, Epidemiology, Clinical Profile, Mortality
Cite this paper
George, S. , Patel, M. and Thakkar, A. (2014) Clinical Profile and In-Hospital Outcome of Patients with Right Ventricular Myocardial Infarction. International Journal of Clinical Medicine, 5, 459-463. doi: 10.4236/ijcm.2014.58064.
George, S. , Patel, M. and Thakkar, A. (2014) Clinical Profile and In-Hospital Outcome of Patients with Right Ventricular Myocardial Infarction. International Journal of Clinical Medicine, 5, 459-463. doi: 10.4236/ijcm.2014.58064.
References
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Clinical and Hemodynamic Features. American Journal of Cardiology, 33,209-214.http://dx.doi.org/10.1016/0002-9149(74)90276-8 [9] Bowers, T.R., O’Neill, W.W., Pica, M. and Goldstein, J.A. (2002) Patterns of Coronary Compromise Resulting in Acute Right Ventricular Ischemic Dysfunction. Circulation, 106, 1104-1109.http://dx.doi.org/10.1161/ 01.CIR.0000027566.51212.3F [10] Goldstein, J.A., Lee, D.T., Pica, M.C., Dixon, S.R. and O’Neill, W.W. (2005) Patterns of Coronary Compromise Leading to Bradyarrhythmias and Hypotension in Inferior Myocardial Infarction. Coronary Artery Disease, 16, 265-274. http://dx.doi.org/10.1097/00019501-200508000-00002 [11] Goldstein, J.A. (2012) Acute Right Ventricular Infarction: Insights for the Interventional Era. Current Problems in Cardiology, 37, 533-557. http://dx.doi.org/10.1016/j.cpcardiol.2012.05.001 [12] Kosuge, M., Ishikawa, T., Morita, S., Ebina, T., Hibi, K., Maejima, N., Umemura, S. and Kimura, K. (2009) Posterior Wall Involvement Attenuates Predictive Value of ST-Segment Elevation in Lead V4R for Right Ventricular Involvement in Inferior Acute Myocardial Infarction. Journal of Cardiology, 54, 386-393.http://dx.doi.org/10.1016/j.jjcc.2009.06.006 [13] Lopez-Sendon, J., Coma-Canella, I., Alcasena, S., Seoane, J. and Gamallo, C. (1985) Electrocardiographic Findings in Acute Right Ventricular Infarction: Sensitivity and Specificity of Electrocardiographic Alterations in Right Precordial Leads V4R, V3R, V1, V2, and V3. Journal of the American College of Cardiology, 6, 1273-1279.http://dx.doi.org/10.1016/ S0735-1097(85)80213-8 [14] Klein, H.O., Tordjman, T., Ninio, R., Sareli, P., Oren, V., Lang, R., Gefen, J., Pauzner, C., Di Segni, E., David, D. and Kaplinsky, E. (1983) The Early Recognition of Right Ventricular Infarction: Diagnostic Accuracy of the Electrocardiographic V4R Lead. Circulation,67,558-565. http://dx.doi.org/ 10.1161/01.CIR.67.3.558 [15] Lorell, B., Leinbach, R.C., Pohost, G.M., Gold, H.K., Dinsmore, R.E., Hutter Jr., A.M., Pastore, J.O. and Desanctis, R.W. (1979) Right Ventricular Infarction. Clinical Diagnosis and Differentiation from Cardiac Tamponade and Pericardial Constriction. American Journal of Cardiology, 43, 465-471. http://dx.doi.org/10.1016/0002-9149(79)90001-8 [16] Dell’Italia, L.J., Starling, M.R. and O’Rourke, R.A. (1983) Physical Examination for Exclusion of Hemodynamically Important Right Ventricular Infarction. Annals of Internal Medicine, 99, 608-611. http://dx.doi.org/10.7326/0003-4819-99-5-608 [17] Dell’Italia, L.J., Starling, M.R., Crawford, M.H., Boros, B.L., Chaudhuri, T.K. and O’Rourke, R.A. (1984) Right Ventricular Infarction: Identification by Hemodynamic Measurements before and after Volume Loading and Correlation with Noninvasive Techniques. Journal of the American College of Cardiology, 4, 931-939.http://dx.doi.org/10.1016/S0735-1097(84)80053-4 [18] Cintron, G.B., Hernandez, E., Linares, E. and Aranda, J.M. (1981) Bedside Recognition, Incidence and Clinical Course of Right Ventricular Infarction. American Journal of Cardiology, 47, 224-227. http://dx.doi.org/10.1016/0002-9149(81)90389-1 [19] Kontos, M.C., Jesse, R.L., Schmidt, K.L., Ornato, J.P. and Tatum, J.L. (1997) Value of Acute Rest Sestamibi Perfusion Imaging for Evaluation of Patients Admitted to the Emergency Department with Chest Pain. Journal of the American College of Cardiology,30,976-982. http://dx.doi.org/10.1016/S0735-1097(97)00264-7 [20] Khan, S., Kundi, A. and Sharieff, S. (2004) Prevalence of Right Ventricular Myocardial Infarction in Patients with Acute Inferior Wall Myocardial Infarction. International Journal of Clinical Practice, 58, 354-357.http://dx.doi.org/10.1111/j.1368-5031.2004.00030.x
[1] Ohzono, K., Koyanagi, S., Urabe, Y., Harasawa, Y., Tomoike, H. and Nakamura, M. (1986) Transmural Distribution of Myocardial Infarction: Difference between the Right and Left Ventricles in a Canine Model. Circulation Research, 59, 63-73. http://dx.doi.org/ 10.1161/01.RES.59.1.63 [2] Santamore, W.P., Lynch, P.R., Heckman, J.L., Bove, A.A. and Meier, G.D. (1976) Left Ventricular Effects on Right Ventricular Developed Pressure. Journal of Applied Physiology, 41, 925-930. [3] Shiraki, H., Yoshikawa, T., Anzai, T., Negishi, K., Takahashi, T., Asakura, Y., Akaishi, M., Mitamura, H. and Ogawa, S. (1998) Association between Preinfarction Angina and a Lower Risk of Right Ventricular Infarction. The New England Journal of Medicine, 338,941-947. http://dx.doi.org/10.1056/ NEJM199804023381402 [4] Haji, S.A. and Movahed, A. (2000) Right Ventricular Infarction—Diagnosis and Treatment. Clinical Cardiology, 23, 473-482. http://dx.doi.org/ 10.1002/clc.4960230721 [5] Mehta, S.R., Eikelboom, J.W., Natarajan, M.K., Diaz, R., Yi, C., Gibbons, R.J. and Yusuf, S. (2001) Impact of Right Ventricular Involvement on Mortality and Morbidity in Patients with Inferior Myocardial Infarction. Journal of the American College of Cardiology,37,37-43. http://dx.doi.org/10.1002/ clc.4960230721 [6] Goldberg, R.J., Gore, .J.M., Alpert, J.S., Osganian, V., de Groot, J., Bade, J., Chen, Z., Frid, D. and Dalen, J.E. (1991) Cardiogenic Shock after Acute Myocardial Infarction. Incidence and Mortality from a Community-Wide Perspective, 1975 to 1988. New England Journal of Medicine, 325, 1117-1122. http://dx.doi.org/10.1056/NEJM199110173251601 [7] Berger, P.B. and Ryan, T.J. (1990) Inferior Myocardial Infarction. High-Risk Subgroups. Circulation, 81, 401-411.http://dx.doi.org/10.1161/01.CIR.81.2.401 [8] Cohn, J.N., Guiha, N.H., Broder, M.I. and Limas, C.J. (1974) Right Ventricular Infarction. Clinical and Hemodynamic Features. American Journal of Cardiology, 33,209-214.http://dx.doi.org/10.1016/0002-9149(74)90276-8 [9] Bowers, T.R., O’Neill, W.W., Pica, M. and Goldstein, J.A. (2002) Patterns of Coronary Compromise Resulting in Acute Right Ventricular Ischemic Dysfunction. Circulation, 106, 1104-1109.http://dx.doi.org/10.1161/ 01.CIR.0000027566.51212.3F [10] Goldstein, J.A., Lee, D.T., Pica, M.C., Dixon, S.R. and O’Neill, W.W. (2005) Patterns of Coronary Compromise Leading to Bradyarrhythmias and Hypotension in Inferior Myocardial Infarction. Coronary Artery Disease, 16, 265-274. http://dx.doi.org/10.1097/00019501-200508000-00002 [11] Goldstein, J.A. (2012) Acute Right Ventricular Infarction: Insights for the Interventional Era. Current Problems in Cardiology, 37, 533-557. http://dx.doi.org/10.1016/j.cpcardiol.2012.05.001 [12] Kosuge, M., Ishikawa, T., Morita, S., Ebina, T., Hibi, K., Maejima, N., Umemura, S. and Kimura, K. (2009) Posterior Wall Involvement Attenuates Predictive Value of ST-Segment Elevation in Lead V4R for Right Ventricular Involvement in Inferior Acute Myocardial Infarction. Journal of Cardiology, 54, 386-393.http://dx.doi.org/10.1016/j.jjcc.2009.06.006 [13] Lopez-Sendon, J., Coma-Canella, I., Alcasena, S., Seoane, J. and Gamallo, C. (1985) Electrocardiographic Findings in Acute Right Ventricular Infarction: Sensitivity and Specificity of Electrocardiographic Alterations in Right Precordial Leads V4R, V3R, V1, V2, and V3. Journal of the American College of Cardiology, 6, 1273-1279.http://dx.doi.org/10.1016/ S0735-1097(85)80213-8 [14] Klein, H.O., Tordjman, T., Ninio, R., Sareli, P., Oren, V., Lang, R., Gefen, J., Pauzner, C., Di Segni, E., David, D. and Kaplinsky, E. (1983) The Early Recognition of Right Ventricular Infarction: Diagnostic Accuracy of the Electrocardiographic V4R Lead. Circulation,67,558-565. http://dx.doi.org/ 10.1161/01.CIR.67.3.558 [15] Lorell, B., Leinbach, R.C., Pohost, G.M., Gold, H.K., Dinsmore, R.E., Hutter Jr., A.M., Pastore, J.O. and Desanctis, R.W. (1979) Right Ventricular Infarction. Clinical Diagnosis and Differentiation from Cardiac Tamponade and Pericardial Constriction. American Journal of Cardiology, 43, 465-471. http://dx.doi.org/10.1016/0002-9149(79)90001-8 [16] Dell’Italia, L.J., Starling, M.R. and O’Rourke, R.A. (1983) Physical Examination for Exclusion of Hemodynamically Important Right Ventricular Infarction. Annals of Internal Medicine, 99, 608-611. http://dx.doi.org/10.7326/0003-4819-99-5-608 [17] Dell’Italia, L.J., Starling, M.R., Crawford, M.H., Boros, B.L., Chaudhuri, T.K. and O’Rourke, R.A. (1984) Right Ventricular Infarction: Identification by Hemodynamic Measurements before and after Volume Loading and Correlation with Noninvasive Techniques. Journal of the American College of Cardiology, 4, 931-939.http://dx.doi.org/10.1016/S0735-1097(84)80053-4 [18] Cintron, G.B., Hernandez, E., Linares, E. and Aranda, J.M. (1981) Bedside Recognition, Incidence and Clinical Course of Right Ventricular Infarction. American Journal of Cardiology, 47, 224-227. http://dx.doi.org/10.1016/0002-9149(81)90389-1 [19] Kontos, M.C., Jesse, R.L., Schmidt, K.L., Ornato, J.P. and Tatum, J.L. (1997) Value of Acute Rest Sestamibi Perfusion Imaging for Evaluation of Patients Admitted to the Emergency Department with Chest Pain. Journal of the American College of Cardiology,30,976-982. http://dx.doi.org/10.1016/S0735-1097(97)00264-7 [20] Khan, S., Kundi, A. and Sharieff, S. (2004) Prevalence of Right Ventricular Myocardial Infarction in Patients with Acute Inferior Wall Myocardial Infarction. International Journal of Clinical Practice, 58, 354-357.http://dx.doi.org/10.1111/j.1368-5031.2004.00030.x