Right ventricular myocardial infarction

Defined as hypotension, elevated jugular pressure, and shock in the presence of clear lungs in patients with acute coronary syndrome.

Right ventricular MI is usually recognized in the setting of an acute left ventricular ST segment elevation (STEMI) MI.

Isolated right ventricular MI is rare.

In most patients with right ventricular MI, the inferior wall of the left ventricle is involved as a result of occlusion of the right coronary artery proximal to the right ventricular branch.

In about 10% of cases in whom right ventricular MI develops the left circumflex artery supplies the right ventricle and a lateral wall STEMI occurs.

The incidence of right ventricular MI occurs in about one third of patients with inferior wall STEMI.

Autopsy studies show right ventricular MI occurs IN more than half of patients with acute MI.

EKG findings suggesting right ventricular acute MI include ST-segment elevation in the inferior leads II,III, and aVF and in the right per cordial chest leads, particularly lead V1.

V1 is the only standard EKG lead that directly images the right ventricle.

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