Right ventricular myocardial infarction: it's incidence, clinical, laboratory, ECG and ECHO characteristics

RV involvement in the infarct increases the risk of hemodynamic collapse; thus, early recognition of RVMI is essential to guide the correct early treatment. Left-sided ECG and difficulties in visualizing RV free wall by ECHO make it´s recognition challenging. Early mechanical reperfusion of affected vessels, adequate fluid replacement and maintaining sufficient heart rate and atrioventricular synchrony are essential in treating RVMI, especially when concomitant cardiogenic shock is present.This study aims to evaluate the incidence of RVMI among STEMI patients, analyze typical characteristics of RVMI by ECG, ECHO, and laboratory values, and to study the incidence of complications arising from the RVMI. Fist 100 patients who were diagnosed with STEMI from the start of the year 2018 (data was collected 2.1-15.12.2018) in Riga East Clinical Hospital with wide laboratory investigations, ECHO and PCI done were screened. Out of the 100 patients, all cases of the RVMI were identified from ECHO results and enrolled in this retrospective quantitative observational study. RVMI incidence, ECG, ECHO characteristics and laboratory values of RVMI were analyzed. In the study group 25 % (25/100) of STEMI patients had signs of RV systolic dysfunction in ECHO, from them 24 (96%) patients were discharged from hospital, 1 (4%) patient died. Mean ranks of ALT, AST were higher and GFR was lower in case TAPSE (tricuspid anulus plane systolic excursion) was decreased. Heart rhythm and conduction disturbances were found in 18 (72%) of RVMI patients. Standard 12-lead ECG did not show any signs indicatory for RVMI in 39% of RVMI cases. RVMI incidence was high in the study group. Kidney and liver function laboratory values worsening may suggest RV systolic function decrease. Standard 12-lead ECG has low efficacy in the diagnostics of RVMI. Implementation of extended ECG with right precordial leads recording is necessary for RVMI early diagnostics improvement.