Transient right-to-left intracardiac shunt following a right ventricular myocardial infarction

Krishnamurthy, Arvindra; White, H. L.; Ahmed, Rizwan

doi:10.1136/bcr-2012-008398

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…[4][5][6][7][8][9][10][11][12] Right-to-left shunting can be considered after excluding more common causes of hypoxemia following MI, such as pulmonary edema from cardiogenic shock or ischemic mitral regurgitation, underlying pulmonary disease, or pulmonary embolism. The modality of choice to diagnose intracardiac right-to-left shunts is transesophageal echocardiography with agitated saline contrast.…”

Section: Discussionmentioning

confidence: 99%

“…Revascularization of the culprit artery is paramount, after which supportive care may suffice, as shunting decreases as the right ventricular function recovers. 12 Supplemental oxygen is often ineffective and positive pressure ventilation may worsen shunting 13 ; many of these interventions are poorly tolerated in the setting of right ventricular failure. 6,9,10 Other options to support a failing right ventricle refractory to medical therapy may include venoarterial extracorporeal membrane oxygenation, atrial septostomy, atrial pacing in patients with bradycardia, and acute mechanical circulatory support devices.…”

Section: Discussionmentioning

confidence: 99%

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The dilemma of refractory hypoxemia after inferior wall myocardial infarction

Albaghdadi

Teleb

Porres‐Aguilar

et al. 2018

Baylor University Medical Center Proceedings

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Patent foramen ovale (PFO) occurs in 25% of people. The decision on whether to close the PFO found after myocardial infarction and specifically right ventricular infarction is debated, with no solid guidelines addressing this subject. Here we present the case of a 59-year-old man who presented with a myocardial infarction and was found to have PFO. He was treated with revascularization of the culprit artery, followed by supportive care. Significant right-to-left shunting may be present in some patients upon positional changes, leading to the so-called platypnea-orthodeoxia syndrome.2 A PFO may allow for paradoxical embolization, which may be the explanation for a proportion of cases of cryptogenic stroke.3 Refractory hypoxemia with an unremarkable chest radiograph or lung exam should always prompt suspicion for a right-to-left shunt. The occurrence of right ventricular infarction, which complicates 40% of posterior wall myocardial infarction (MI), may lead to right-toleft shunting, due to restrictive diastolic physiology of the ischemic right ventricle. 4-12 CASE PRESENTATIONA 59-year-old Hispanic man with no significant past medical history presented to the emergency department in Juarez, Mexico, with severe left-sided chest pain of 1-hour duration. His electrocardiogram confirmed an acute inferior ST elevation MI (Figure 1). Because percutaneous coronary intervention was not available locally, the patient was given thrombolytics. He developed worsening dyspnea, hypotension, and bradycardia. Thrombolytic infusion was stopped and he was transferred to our facility for further management. Upon arrival, his oxygen saturation was 82% despite a 15-L non-rebreathing mask. On examination, he had prominent jugular venous ingurgitation with a positive Kussmaul sign, an S4 gallop, and clear lungs to auscultation.

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