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Right ventricular infarction in the pre-hospital setting: A hidden complication

07 December 2012
Features
02 December 2012
Volume 4 · Issue 12

Abstract

Right ventricular infarction (RVI) can occur in isolation but is more commonly associated with inferior myocardial infarction (IMI). It has a higher mortality rate compared to isolated left ventricular infarction and often presents with complications. Early recognition of RVI in paramedic practice is key to decreasing patient mortality. This article focuses on RVI within the pre-hospital environment. Particular emphasis is placed on right precordial electrocardiogram (ECG) lead placement, judicious administration of intravenous fluids in the hypotensive patient, and specific complications associated with vasodilatory drugs in RVI.

In the UK, it is estimated that around 103 000 people suffer an acute myocardial infarction each year (Townsend et al, 2012). Paramedics will attend to a number of these patients, delivering specific life saving care and transporting to an appropriate healthcare facility. The use of the 12 lead electrocardiograms (ECGs) by paramedics to diagnose an ST elevation myocardial infarction (MI) is standard procedure, as is the subsequent management of these patients.

Infarctions affecting the right ventricle can occur in isolation however they are more commonly found in association with IMI. Consequently, right ventricular involvement should be considered in all patients presenting with an inferior myocardial infarction (IMI). Patients suffering a right ventricular infarction (RVI) may require alternative treatment methods due to the high risk of haemodynamic instability and cardiac arrhythmia associated with this condition (Yager, 1996; Goldstein, 2002; Pfisterer, 2003).

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Electrocardiogram
Inferior myocardial infarction
Myocardial infarction
Pre-hospital
Right sided electrocardiogram
Right ventricular infarction