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Table of Content - Volume 6 Issue 3 - June 2017


A study of various complications of right ventricular infarction at tertiary health care centre

 

Dilip Pandurang Patil

 

Assistant Professor, Department of Medicine, Krishna institute of Medical sciences " Deemed To Be University" Karad

Dist_ Satara-415539, Maharashtra, INDIA.

Email: patilhospitalkarad@gmail.com

 

Abstract              Background: Myocardial infarction was previously thought to be a disease of mainly the left ventricle. Right ventricular infarction was just a pathological entity. Aims and Objectives: To Study various complications of right ventricular infarction at tertiary health care centre. Methodology: This cross-sectional study was carried out at public charitable trust attached too medical college between January 1994 to December 1994 in the 55 patients of acute inferior wall myocardial infarction admitted to hospital. Here various complications occurred in every patients was noted. Result: In our study the majority of the patients were in the age group of 40-50 were 30.91% followed by 50-60 were 23.64%, >60 were 21.82%, 30-40 were 16.36%, 20-30 were 7.27%. The majority of the patients were Male i.e. 58.18% followed by Female were 41.82%. The most common complications were LVF in 49.09%, followed by Hypotension in 23.64%, A.V. Block in 20.00%, Bundle Branch B. -16.36%, VPB(Ventricular Premature Beat) in 10.91%, Ventricular Tachycardia in 3.64%, V. fibrillation in 3.64%, A.V. Dissociation and Atrial arrhythmia in 1.82%, Death occurred in 1.82%. Conclusion: It can be concluded from our study that the most common age was 40-50 the most common complications were LVF, Hypotension, A.V. block etc.

Key Words: Right ventricular infarction, RVF (right ventricular failure), LVF (left ventricular failure), Bundle Branch Block (BBB), VPB (Ventricular Premature Beat)

 

INTRODUCTION

Myocardial infarction was previously thought to be a disease of mainly the left ventricle. Right ventricular infarction was just a pathological entity. Several authors had recognized the existence of the right ventricular dysfunction in context of acute myocardial infarction but little attention was paid to its clinical aspects. In 1974, Cohn 1 for the first time described potentially serious and unique haemodynamic consequences of right ventricular infarction. The advent of more sophisticated diagnostic techniques and more precise haemodynamic measurement has demonstrated that right ventricular infarction is well defined clinical entity and value of recognizing patients with predominant right ventricular dysfunction is related not only to instituting appropriate therapy for severe pump failure but also to avoid inappropriate therapy. Although isolated right ventricular infarction had been described in autopsy reports as less than 3% of all acute myocardial infarction, 2 the incidence of right ventricular infarction associated with inferior wall myocardial infarction has been shown to be as high as 30%–50%. 3 It has also been shown that right ventricular infarction occurs exclusively in association with inferior myocardial infarction or inferoposterior myocardial infarction 4. Prompt fluid therapy may abort the vicious cycle set to motion by right ventricular infarction, which if treated in conventional way or neglected tends to lead to true cardiogenic shock. 5

 

MATERIAL AND METHODS

This cross-sectional study was carried out at public charitable trust attached too medical college between January 1994 to December 1994 in the 55 patients of acute inferior wall myocardial infarction admitted to hospital. The patients with history of Chest pain >24hrs., patients whose initial ECG’s showed an anteroseptal or anterolateral wall MI, patients with chronic lung disease, corpulmonale, patients with previous history of MI. All the necessary investigations were done, the diagnosis of acute inferior wall MI was made as typical history of chest pain, ST segment elevation in leads II, III and avF and by development of pathological q waves in above mentioned leads. Similar changes in lead V5 and V6 (Lateral extension) and lead V2 diagnosis true posterior wall infarction. Tall R waves in V1 and V 2 and increased serum enzymes (SGOT). The diagnosis of right ventricular infarction was made by the criteria of Croft et al ST segment elevation at 0.1 mv or more in one or more of the right precordial leads ( V3R, V4R,V5R and V6R) in those patients who satisfied the criteria for an inferior wall MI. Here various complications occurred in every patients was noted.

 

RESULT

 

Table 1: Distribution of the patients as per the age

Age(Yrs.)

No.

Percentage (%)

20-30

4

7.27

30-40

9

16.36

40-50

17

30.91

50-60

13

23.64

>60

12

21.82

Total

55

100.00

The majority of the patients were in the age group of 40-50 were 30.91% followed by 50-60 were 23.64%, >60 were 21.82%, 30-40 were 16.36%, 20-30 were 7.27%.

 

Table 2: Distribution of the patients as per the sex

Sex

No.

Percentage (%)

Male

32

58.18

Female

23

41.82

Total

55

100.00

 The majority of the patients were Male i.e. 58.18% followed by Female were 41.82%.

 

 

 

 

 

 

Table 3: Distribution of the patients as per the complications

Complications

No.

Percentage (%)

LVF

27

49.09

Hypotension

13

23.64

A.V. Block

11

20.00

Bundle Branch B.

9

16.36

VPB(Ventricular Premature Beat)

6

10.91

Ventricular Tachycardia

2

3.64

V. fibrillation

2

3.64

A.V. Dissociation

1

1.82

Atrial arrhythmia

1

1.82

Death

1

1.82

The most common complications were LVF in 49.09%, followed by Hypotension in 23.64%, A.V. Block in 20.00%, Bundle Branch B. -16.36%, VPB(Ventricular Premature Beat) in 10.91% Ventricular Tachycardia in 3.64%, V. fibrillation in 3.64%, A.V. Dissociation and Atrial arrhythmia in 1.82%, Death occurred in 1.82%.

 

DISCUSSION

Although right ventricular infarction occurs in more than 30% of patients with inferior posterior left ventricular myocardial infarction, hemodynamically significant right ventricular infarction occurs in less than 10% of these patients.6,7 A right ventricular infarct should be considered in all patients who present with an acute inferior wall myocardial infarction, especially in the setting of a low cardiac output. Patients may describe symptoms consistent with hypotension. A subtle clue to the presence of hemodynamically significant right ventricular infarction is a marked sensitivity to preload-reducing agents such as nitrates, morphine, or diuretics. [8]Other presentations include high-grade atrioventricular block, tricuspid regurgitation,9 cardiogenic shock, right ventricular free wall rupture, and cardiac tamponade. Should a patient with right ventricular infarction experience unexplained hypoxia despite administration of 100% oxygen, right-to-left shunting at the atrial level—through a patent foramen ovale or an atrial septal defect—in the presence of right ventricular failure and increased right atrial pressure must be considered.10,11 Patients with extensive right ventricular necrosis are at risk for right ventricular catheter–related perforation, and passage of a catheter or pacemaker in the chamber must always be performed with great care.12 In our study the majority of the patients were in the age group of 40-50 were 30.91% followed by 50-60 were 23.64%, >60 were 21.82%, 30-40 were 16.36%, 20-30 were 7.27%. The majority of the patients were Male i.e. 58.18% followed by Female were 41.82%. The most common complications were LVF in 49.09%, followed by Hypotension in 23.64%, A.V. Block in 20.00%, Bundle Branch B. -16.36%, VPB(Ventricular Premature Beat) in 10.91%, Ventricular Tachycardia in 3.64%, V. fibrillation in 3.64%, A.V. Dissociation and Atrial arrhythmia in 1.82%, Death occurred in 1.82%. Similar to Daanish Aijaz Chhapra13, they found Of the total studied 50 patients, 16 patients had right ventricular infarction in association with inferior wall infarction of left ventricle and also Complications and in-hospital mortality rates were more common in patients with right ventricular infarction than in patients without it.

 

CONCLUSION

It can be concluded from our study that the most common age was 40-50 the most common complications were LVF, Hypotension, A.V. block etc.

 

REFERENCES

  1. Cohn J.N. Right ventricular infarction revisited. Am J Cardiol. 1979; 43:666. 
  2. Lovell B., Leinbach R.C., Pohost J.M. Right ventricular infarction; clinical diagnosis and differentiation from cardiac tamponade and pericardial constriction. Am J Cardiol. 1979; 43:465. 
  3. Goldstein J.A. Pathophysiology and management of right heart ischemia. J Am Coll Cardiol. 2002; 40:841. 
  4. Khan S., Kundi A., Sharieff S. Prevalence of right ventricular myocardial infarction in patients with acute inferior wall myocardial infarction. Int J Clin Pract. 2004; 58:354–357. 
  5. Dimitrios G., Ketikoglou M.D., Karvounis H.I., Papadopoulos C.E., Theodra A. Echocardiographic evaluation of spontaneous recovery of right ventricular systolic and diastolic function in patients with acute right ventricular infarction associated with posterior wall left ventricular infarction. Am J Cardiol. 2004; 93:911–913.
  6. Lisbona R, Sniderman A, Derbekyan V, Lande I, Boudreau R. Phase and amplitude imaging in the diagnosis of acute right ventricular damage in inferior infarction. Clin Nucl Med. 1983 Nov. 8(11):517-20. 
  7. Martin W, Tweddel A, McGhie I, Hutton I. The evaluation of right ventricular function in acute myocardial infarction by xenon-133. Nucl Med Commun. 1989 Jan. 10(1):35-43. Mittal SR. Isolated right ventricular infarction. Int J Cardiol. 1994 Aug. 46(1):53-60. 
  8. Silverman BD, Carabajal NR, Chorches MA, Taranto AI. Tricuspid regurgitation and acute myocardial infarction. Arch Intern Med. 1982 Jul. 142(7):1394-5. 
  9. Nader DA, Ceretto WJ, Vieweg WV. Atrial pacing in the management of right ventricular infarction. South Med J. 1981 Mar. 74(3):362-3. 
  10. Pfisterer M, Emmenegger H, Muller-Brand J, Burkart F. Prevalence and extent of right ventricular dysfunction after myocardial infarction--relation to location and extent of infarction and left ventricular function. Int J Cardiol. 1990 Sep. 28(3):325-32..
  11. Sugimoto T, Ogawa K, Asada T, et al. Surgical treatment of ventricular septal perforation with right ventricular infarction. J Cardiovasc Surg (Torino). 1996 Feb. 37(1):71-4. 
  12. Daanish Aijaz Chhapra Sanket Kaushik Mahajan et al. A study of the clinical profile of right ventricular infarction in context to inferior wall myocardial infarction in a tertiary care centre. J Cardiovasc Dis Res. 2013 Sep; 4(3): 170–176.

 

 

 

 

 

 

 

 

 

 

 

 

 




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