Optimal value of filling pressure in the right side of the heart in acute right ventricular infarction

Abstract

Haemodynamic monitoring was performed within the first 48 hours after the onset of symptoms in basal conditions, during volume loading, and during infusion of glyceryl trinitrate in 41 patients who fulfilled the diagnostic electrocardiographic and haemodynamic criteria of right ventricular infarction. In most patients an increase of mean right atrial pressure up to 10-14 mm Hg was followed by an increase in right ventricular stroke work index. But raising the mean right atrial pressure above 14 mm Hg was almost always accompanied by a reduction in right ventricular stroke work index. When the mean right atrial pressure was reduced by intravenous glyceryl trinitrate to less than 14 mm Hg the right ventricular stroke index increased. The same response was seen with cardiac and stroke index. The mean (SD) values of optimal right atrial and pulmonary capillary pressures were 11.7 (2.1) and 16.5 (2.7) mm Hg respectively. Thus cardiac and stroke index increased and the right ventricle reached its maximum stroke work index when the filling pressure was 10-14 mm Hg. These values may be regarded as the optimal level of right ventricular filling pressure in patients with right ventricular infarction.