Introduction

Coronary artery disease is the commonest form of heart disease and the leading cause of morbidity and mortality throughout the world. Its prevalence among Indians has doubled during the past two decades¹. Myocardial infarction is one of the most common diagnosis in hospitalized patients. Acute myocardial infarction is the single most important cause of morbidity and mortality in developed countries². In developing countries, it follows infections. Now it is recognized as one of the major non-communicable public health problem. There is increased incidence of acute myocardial infarction in developing countries because of multiple factors like unhealthy food habits, stress factors, increase in habits like smoking and alcohol and rapid urbanization^3,4. There is an advent of newer diagnostic techniques for the disease, but still ECG remains the pillar as it is non-invasive and easily available. Now right ventricular MI is diagnosed using right sided precordial leads (RPL) with introduction of RPL diagnosis of RVI has become easy and economical. RVMI is not uncommon in acute MI and has its own therapeutic and prognostic implications. Management of RVMI differs from other MIs. The presence of RVI is known to increase the chances of cardiogenic shock, arrhythmias and conduction blocks¹.

Objectives

1. To study the frequency and clinical profile of right ventricular MI in patient with inferior wall MI.
2. To study prognosis in a patient admitted with right ventricular MI in patient among inferior wall MI.

1. Kakouros N, Cokkinos DV. Right ventricular myocardial infarction: pathophysiology, diagnosis, and management. Postgrad Med J 2010; 86:719.
2. Leo Schamaroth. A text book of electrocardiography. 1995.
3. Fisch Charles. Electrocardiography. Braunwalds a text book of Cardiovascular medicine. New York McGraw Hill, 5th edition: 108.
4. John A Farmer, Antonio M Gottojr. Text book of Cardiovascular Medicine, 5th edn. 1148.
5. Gazino JM et al. Relation between systemic hypertension and blood lipids on risk of MI. Am J Cardiol 1999; 84(7): 768-773.
6. Kinch and Hyan. RVI. NEJM 1994; 330: 1211 to 1217.
7. GISSI study. Effectiveness of IV thrombolytic therapy treatment in AMI. Lancet 1986; 1: 397-401.
8. Ferguson JJ, Diver DJ, Boldt M Et al. Significance of nitroglycerine induced hypotension with IMI. Am J Cardiol 1989; 68: 311.
9. Castagine AD, Herve C, Duval A et al. Pre hospital versus hospital use of thrombolytics. Am J of Cardiol 64: 628-636.
10. Michael J Davis. Pathology of coronary atherosclerosis. Hurst’s. The Heart, 9^th New York McGraw Hill: 1161-1189.
11. Erhardt CR, Sjogren A Wahlberg. Single Rt precordial lead in Diagnosis of RVI in IMI. Am Heart J 1976; 191: 571.
12. Berger PG, Rucco NA, Timon TC et al. The impact of thrombolytic therapy on RVI complicating IMI, Results from thrombolysis in IMI. Circulation 1989; 80 : 311-313.
13. Goto, Yamamoto J, Saito M Et al. Effects of RV ischemia on LV geometry and the end diastolic pressure volume relationship in dog. Circulation 1985; 72: 1104.
14. Kneiakes BJ, Ports TA, Botvinic EH et al. RVMI with ventricular septal rupture. Am Heart J 1984; 107: 1257.
15. Kakouros N, Kakouros S, Lekakis J, et al. Tissue Doppler imaging of the tricuspid annulus and myocardial performance index in the evaluation of right ventricular involvement in the acute and late phase of a first inferior myocardial infarction. Echocardiography 2011; 28:311.
16. Adam JE, Sicard JM, Allen BT et al. Diagnosis of perioperative MI with management of cardiac Tropon in I. NEJM 1994; 330: 670.
17. Braat SH, Brugada P, de Zwaan C Et al. Value of ECG in diagnosing RV involvement in patients with Acute IMI. Br Heart J 1983; 49: 368.

Dr Rajiv Girdhar

Assistant Professor in Cardiology Department