Right ventricular myocardial infarction risk factors

Right ventricular myocardial infarction Microchapters
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Overview
Pathophysiology
Pathophysiology of Reperfusion
Gross Pathology
Histopathology
Causes
Differentiating Right ventricular myocardial infarction from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Electrocardiogram
Chest X Ray
Echocardiography or Ultrasound
Coronary Angiography
Other Imaging Findings
Treatment
Initial Care
Pharmacological Reperfusion
Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)
Fibrinolysis
Mechanical Reperfusion
The Importance of Reducing Door-to-Balloon Times
Primary PCI
Adjunctive and Rescue PCI
Rescue PCI
Facilitated PCI
Adjunctive PCI
CABG
Management of Patients Who Were Not Reperfused
Assessing Success of Reperfusion
Antithrombin Therapy
Antithrombin Therapy
Unfractionated Heparin
Low Molecular Weight Heparinoid Therapy
Direct Thrombin Inhibitor Therapy
Factor Xa Inhibition
DVT Prophylaxis
Long Term Anticoagulation
Antiplatelet Agents
Aspirin
Thienopyridine Therapy
Glycoprotein IIbIIIa Inhibition
Other Initial Therapy
Inhibition of the Renin-Angiotensin-Aldosterone System
Magnesium Therapy
Glucose Control
Calcium Channel Blocker Therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Risk Factors

• The presence of right ventricular infarction adversely affects the early prognosis. One study, for example, evaluated 200 consecutive patients with acute inferior myocardial infarction. 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 inferior wall myocardial infarction are at a 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.
• For patients who survive an acute right ventricular infarction, the prognosis is generally good. As an example, among 522 patients with an 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). 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 decreased oxygen demand of the thin-walled right ventricle. These patients may, however, have a more frequent requirement for a permanent pacemaker.