View source for Right ventricular myocardial infarction natural history, complications and prognosis

{{Right ventricular myocardial infarction}}
{{CMG}}

==Overview==
The presence of [[Right ventricular myocardial infarction|right ventricular infarction]] adversely affects the early prognosis. Elderly patients who have right ventricular involvement with an [[Acute myocardial infarction|inferior wall myocardial infarction]] are at particularly high risk. For patients who survive an acute [[Right ventricular myocardial infarction|right ventricular infarction]], however, the prognosis is generally good.

==Prognosis== 
* The presence of [[Right ventricular myocardial infarction|right ventricular infarction]] adversely affects the early prognosis. One study, for example, evaluated 200 consecutive patients with acute inferior myocardial infarction. <ref>Zehender, M, Kasper, W, Kauder, E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328:981. PMID 8450875</ref> Those with ST elevation in V4R had an almost eight-fold increase in in-hospital mortality (31 versus 6 percent) and morbidity when compared to those without changes in V4R.
* Elderly patients who have right ventricular involvement with an [[Acute myocardial infarction|inferior wall myocardial infarction]] are at particularly high risk. In a study of 198 patients ≥ 75 years of age, right ventricular involvement was associated with an in-hospital mortality of 47 percent compared to a 10 percent mortality in the absence of right ventricular involvement <ref>Bueno, H, Lopez-Palop, R, Bermejo, J, et al. In-hospital outcome of elderly patients with acute inferior myocardial infarction and right ventricular involvement. Circulation 1997; 96:436. PMID 9788824</ref>
* For patients who survive an acute [[Right ventricular myocardial infarction|right ventricular infarction]], however, the prognosis is generally good. As an example, among 522 patients with an [[Acute myocardial infarction|inferior wall infarction]] who were treated with a thrombolytic agent and [[hirudin]] or [[heparin]] in the HIT-4 study, 32 percent had right ventricular involvement and these patients had a higher 30 day mortality when compared to those without right ventricular involvement (5.9 versus 2.5 percent. <ref>Zeymer, U, Neuhaus, K-L, Wegscheider, K, et al. Effects of thrombolytic therapy in acute inferior myocardial infarction with and without right ventricular involvement. J Am Coll Cardiol 1998; 32:876. PMID 9768705</ref> However, this was related to a larger infarct size rather than right ventricular involvement; right ventricular involvement was not an independent predictor of survival.
* The right ventricle frequently recovers the majority of its function, probably due at least in part to a decreased oxygen demand of the thin-walled right ventricle. <ref>Williams, JF. Right ventricular infarction. Clin Cardiol 1990; 13:309. PMID 2189611</ref> <ref>Cohn, JN. Right ventricular infarction revisited. Am J Cardiol 1979; 43:666. PMID 420117</ref> These patients may, however, have a more frequent requirement for a permanent [[pacemaker]]. <ref>Zehender, M, Kasper, W, Kauder, E, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med 1993; 328:981. PMID 8450875</ref>

==References==
{{reflist|2}}

[[Category:Cardiology]]
[[Category:Intensive care medicine]]
[[Category:Emergency medicine]]

{{WH}}
{{WS}}