The challenges in the management of right ventricular infarction

Taku Inohara, Shun Kosaka, Keiichi Fukuda, Venu Menon

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

In recent years, right ventricular (RV) infarction seems to be underdiagnosed in most cases of acute myocardial ischaemia despite its frequent association with inferior-wall and, occasionally, anterior-wall myocardial infarction (MI). However, its initial management is drastically different from that of left ventricular MI, and studies have indicated that RV infarction remains associated with significant morbidity and mortality, even in the mechanical reperfusion era. The pathophysiology of RV infarction involves the interaction between the right and left ventricle (LV), and the mechanism has been clarified with the advent of diagnostic non-invasive modalities, such as echocardiography and cardiac magnetic resonance. In recent years, considerable progress has been made in the treatment of RV infarction; early revascularization remains the cornerstone of the management, and fluid resuscitation, with appropriate target selection, is necessary to maintain appropriate preload. Early recognition in intensive care with clear understanding of the pathophysiology is essential to improve its prognosis. In terms of management, the support strategy for RV dysfunction is different from that for LV dysfunction since the former may often be temporary. Along with early reperfusion, maintenance of an adequate heart rate and atrioventricular synchrony are essential to sustain a sufficient cardiac output in patients with RV infarction. In refractory cases, more intensive mechanical support is required, and new therapeutic options, such as Tandem-Heart or percutaneous cardiopulmonary support systems, are being developed.

Original languageEnglish
Pages (from-to)226-234
Number of pages9
JournalEuropean Heart Journal: Acute Cardiovascular Care
Volume2
Issue number3
DOIs
Publication statusPublished - 2013

Fingerprint

Infarction
Heart Ventricles
Reperfusion
Anterior Wall Myocardial Infarction
Right Ventricular Dysfunction
Patient Rights
Critical Care
Resuscitation
Cardiac Output
Myocardial Ischemia
Echocardiography
Magnetic Resonance Spectroscopy
Heart Rate
Myocardial Infarction
Morbidity
Mortality
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Critical Care and Intensive Care Medicine

Cite this

The challenges in the management of right ventricular infarction. / Inohara, Taku; Kosaka, Shun; Fukuda, Keiichi; Menon, Venu.

In: European Heart Journal: Acute Cardiovascular Care, Vol. 2, No. 3, 2013, p. 226-234.

Research output: Contribution to journalArticle

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