References
Understanding right ventricular myocardial infarction in prehospital care
Abstract
Right ventricular myocardial infarction (RVMI) most commonly occurs in relation to an inferior myocardial infarction. Patients with this condition where the culprit right coronary artery (RCA) is occluded have a poor prognosis. Early recognition and the specific treatment pathway for RVMI differ from the treatment for general acute coronary syndrome (ACS) which could help the paramedic to treat this condition more appropriately. This article explores current guidelines for the recognition and treatment of RVMI and the possible application of specific guidelines in a prehospital setting with regards to using right-sided precordial ECG, the administration of fluids and potential complications arising from vasodilatory drugs. Furthermore, the purpose of this article is to help educate and develop the understanding of RVMI in this high-risk subgroup who have an increased morbidity and mortality.
The most critical time in ST-elevation myocardial infarction (STEMI) is the prehospital stage and a reduction in mortality among these patients can be attributed to the correct treatment in a well-timed manner (Tubaro et al, 2011). The emergency service ambulance remains the first port of call for approximately 80% of patients exhibiting STEMI and, with the support of the use of the 12-lead electrocardiogram (ECG), clinicians can make the appropriate decision to transport the patient for suitable treatment (Association of Ambulance Chief Executives (AACE), 2019). According to Albulushi et al (2018), approximately 30–50% of inferior myocardial infarctions (MI) are related to right ventricular involvement. RVMI is mainly due to the occlusion of the right coronary artery (RCA) proximal to the main right ventricular (RV) branch in relation to an inferior MI. However, this could also be due to occlusion of the left circumflex artery or, less commonly, the left anterior descending artery (Kakouros and Cokkinos, 2010). Patients displaying involvement of the right ventricle, associated with right coronary artery occlusion, have a high mortality rate (Liu et al, 2005).
Subscribe to get full access to the Journal of Paramedic Practice
Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.
What's included
-
CPD Focus
-
Develop your career
-
Stay informed