Right Ventricular Involvement in Inferior Myocardial Wall Infarction: Incidence, Clinical Spectrum and In-Hospital Outcome.

Abstract

Right ventricular infarction (RVI) complicating inferior wall myocardial infarction (MI) is common, associated with morbidity and mortality, and requires thrombolytic therapy. Electrocardiogram (ECG) through right precordial leads (VJR to V6R» is a useful and convenient tool of diagnosing RVI. We studied 50 (38 males, 12 females) patients with acute inferior wall MI to evaluate the clinical course and in-hospital outcome with regard to the presence or absence of RVI as diagnosed by ST -segment elevation in leads VJ to V6R on ECG, which was repeated daily to follow for the reversion of ST-segment elevation. Continuous monitoring was done for 72 hours. All patients were managed with standard treatment protocol. In-hospital outcome of all patients was observed for any dysrrhythmia or cardiogenic shock. The mean age was 56 ± 11 years. Thirty-five (70%) patients were without RVI and 15 (30%) had it with no difference in demographic profile and previous history of ischemic heart disease (IHD). Fourteen percent patients died of inferior wall MI, 5.7% in group I and 33.3% in group II. In-hospital complications were more in RVI i.e, cardiogenic shock (P<0.004), complete atrioventricular (AV) block (P<0.005) and bradycardia (P< 0.0.t) but there was no difference for other dysrrhythmias. In-hospital mortality may be high upto 31% with RVI complicating inferior wall MI, we observed it as 33.3%. Five diagnostic procedures like autopsy, coronary angiography, echocardiography, haemodynamic measurements, echocardiography and ECG have shown that ST segment elevation in lead V.R had an overall sensitivity of 88%, 78% specificity and 83% accuracy in diagnosing RVI. We observed 30% patients having RVI with inferior wall MI as compared to 19-61% in other studies. We conclude that right ventricular infarction can be diagnosed reliably on the basis of ST-segment elevation of ≥01mm in right precardial leads VJR to V,R in patients with inferior wall MI to stratify further risks and their treatment.