[Right ventricular infarct--a rarely diagnosed site]

Abstract

RVI is usually associated to a left ventricular (postero-inferior) myocardial infarction. Its occurrence as an isolated entity is extremely infrequent. Clinical signs suggesting the diagnosis are: predominance of right ventricular failure, Kussmaul's sign and rupture of the interventricular septum. The most sensitive diagnostic method is 2D-ECHO (51% sensitivity), followed by nuclear angiocardiography (37%) and right heart catheterization (26%). Electrocardiographic evidence of RVI is obtained only by routine recording of right precordial leads in patients with transmural postero-inferior left ventricular infarctions. Specific therapeutic measures include use of plasma expanders in order to achieve an increase of cardiac output. Agents that augment left ventricular emptying, as sodium nitroprusside dopamine or dobutamine are useful in cases with coexisting left ventricular disfunction. Avoidance of diuretics administration, in spite of evidence of right ventricular failure is essential to the preservation of a normal cardiac output.