Document Detail

Pathophysiology and clinical management of right heart ischemia.
MedLine Citation:
PMID:  10448614     Owner:  NLM     Status:  MEDLINE    
Right ventricular (RV) ischemia occurs in 50% of patients with acute inferior myocardial infarction, and may result in severe hemodynamic compromise associated with poor clinical outcome. Right coronary artery occlusion proximal to the RV branches results in RV systolic dysfunction, which decreases transpulmonary delivery of left ventricular (LV) preload and diminishes cardiac output. The ischemic right ventricle is stiff, dilated, and volume dependent, resulting in pandiastolic RV dysfunction. Under these conditions, RV pressure generation and output depend on LV-septal contractile contributions. When the culprit coronary lesion is distal to the right atrial (RA) branches, augmented RA contractility enhances RV performance and optimizes cardiac output. Conversely, more proximal occlusions result in ischemic depression of RA contractility, which impairs RV filling and performance, leading to more severe hemodynamic compromise. Bradyarrhythmias limit the output generated by the rate-dependent noncompliant ventricles. Patients with RV ischemia and hemodynamic compromise often respond to volume resuscitation and restoration of a physiologic rhythm. In some patients, parenteral inotropic stimulation may be required. The ischemic right ventricle appears to be relatively resistant to infarction and has a remarkable ability to recover. The term RV infarction appears to be a misnomer, as RV performance improves spontaneously even in the absence of reperfusion. Reperfusion, however, enhances the recovery of RV performance and improves the clinical course.
J A Goldstein
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in cardiology     Volume:  14     ISSN:  0268-4705     ISO Abbreviation:  Curr. Opin. Cardiol.     Publication Date:  1999 Jul 
Date Detail:
Created Date:  1999-10-07     Completed Date:  1999-10-07     Revised Date:  2006-05-04    
Medline Journal Info:
Nlm Unique ID:  8608087     Medline TA:  Curr Opin Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  329-39     Citation Subset:  IM    
Division of Cardiology, William Beaumont Hospital, Royal Oak, MI 48073-6769, USA.
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MeSH Terms
Diastole / physiology
Myocardial Ischemia / physiopathology*,  radiography,  therapy*,  ultrasonography
Myocardial Reperfusion
Systole / physiology
Time Factors
Ventricular Dysfunction, Right / physiopathology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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