Acute coronary syndrome, right ventricular dysfunction and cardiogenic shock: A diagnostic challenge

Abstract

Right ventricular infarction is uncommon in isolation but can be observed in 50% of cases of inferior wall myocardial infarction. Diagnosis is difficult and suspicion of this condition should always be borne in mind. Progression to cardiogenic shock is not uncommon, when the outcome is similar to left ventricular infarction; mortality can reach 60%. We present the case of a 64-year-old woman with known coronary disease who was admitted to our coronary care unit after an anterior myocardial infarction. Cardiac catheterization showed diffuse stenosis of the left descending and 70% stenosis of the posterior descending arteries. She was surgically revascularized with a favorable evolution, but was later readmitted for acute decompensated heart failure with cardiogenic shock. She was refractory to medical therapy, with biventricular dysfunction on echocardiographic examination. Cardiac magnetic resonance imaging confirmed the diagnosis of right ventricular infarction.

Approach to Decompensated Right Heart Failure in the Acute Setting

“…In patients experiencing a right-sided myocardial infarction (MI), reduced contractility may lead to acute right heart failure. Right ventricular infarction is rare in isolation but can be seen in approximately 50% of inferior MI [31]. A patient presenting with persistent hypotension with increased jugular venous distension in the setting of clear lung fields should raise suspicion for right ventricular infarction [31].…”

“…Right ventricular infarction is rare in isolation but can be seen in approximately 50% of inferior MI [31]. A patient presenting with persistent hypotension with increased jugular venous distension in the setting of clear lung fields should raise suspicion for right ventricular infarction [31]. The treatment for RV infarction includes percutaneous coronary intervention or systemic thrombolytics [2,3,9,31].…”

“…A patient presenting with persistent hypotension with increased jugular venous distension in the setting of clear lung fields should raise suspicion for right ventricular infarction [31]. The treatment for RV infarction includes percutaneous coronary intervention or systemic thrombolytics [2,3,9,31]. Patients with RV infarction are preload-dependent; as such, medications that reduce preload, such as nitrates and diuretics, should be used with caution [3].…”