Heart Failure After Right Ventricular Myocardial Infarction.
Matthias P NägeleAndreas J FlammerPublished in: Current heart failure reports (2022)
While HF after RVMI is classically seen after acute proximal right coronary artery occlusion, RV dysfunction may also occur after larger infarctions in the left coronary artery. Because of its different anatomy and physiology, the RV appears to be more resistant to permanent infarction compared to the LV with greater potential for recovery of ischemic myocardium. Hypotension and elevated jugular pressure in the presence of clear lung fields are hallmark signs of RV failure and should prompt confirmation by echocardiography. Management decisions are still mainly based on small studies and extrapolation of findings from LV failure. Early revascularization improves short- and long-term outcomes. Acute management should further focus on optimization of preload and afterload, maintenance of sufficient perfusion pressures, and prompt management of arrhythmias and concomitant LV failure, if present. In case of cardiogenic shock, use of vasopressors and/or inotropes should be considered along with timely use of mechanical circulatory support (MCS) in eligible patients. HF after RVMI is still a marker of worse outcome in acute coronary syndrome. Prompt revascularization, careful medical therapy with attention to the special physiology of the RV, and selected use of MCS provide the RV the time it needs to recover from the ischemic insult.
Keyphrases
- mycobacterium tuberculosis
- coronary artery
- heart failure
- acute coronary syndrome
- percutaneous coronary intervention
- left ventricular
- pulmonary artery
- end stage renal disease
- acute heart failure
- newly diagnosed
- coronary artery bypass grafting
- chronic kidney disease
- ischemia reperfusion injury
- computed tomography
- coronary artery disease
- magnetic resonance
- pulmonary hypertension
- liver failure
- stem cells
- cell therapy
- intensive care unit
- pulmonary arterial hypertension
- bone marrow
- mechanical ventilation