Setaro J F, Cabin H S
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Cardiol Clin. 1992 Feb;10(1):69-90.
Right ventricular myocardial infarction, long unrecognized because of a lack of diagnostic methods and unsupported beliefs regarding the dispensability of the right ventricle, may now be diagnosed using well-accepted criteria. Right ventricular infarction is clearly associated with anterior left ventricular infarction as well as inferior infarction. It may occur in 30% to 40% of patients with inferior infarction, although a much smaller percentage experience hemodynamic instability on the basis of right ventricular infarction. Pathophysiologically, right ventricular systolic and diastolic dysfunction are exacerbated by pericardial restraint and concomitant left ventricular dysfunction, accounting for the characteristic findings of cardiogenic shock and marked preload dependence in many patients. Right ventricular infarction may be suspected on the grounds of clinical presentation, physical examination, and enzymatic findings, and is confirmed using well-defined electrocardiographic, radionuclide, echocardiographic, and hemodynamic criteria. Once diagnosed, right ventricular infarction requires specific hemodynamic and pharmacologic management, including the judicious use of volume expansion and inotropic support. Several forms of mechanical and surgical intervention are of therapeutic value in treating hemodynamic disturbances and recognized complications. With appropriate management, the prognosis for patients with right ventricular infarction is generally favorable.
右心室心肌梗死，长期以来因缺乏诊断方法以及关于右心室可缺如的错误观念而未被充分认识，如今可采用公认的标准进行诊断。右心室梗死与左心室前壁梗死以及下壁梗死明显相关。它可能发生在30%至40%的下壁梗死患者中，尽管仅有小部分患者因右心室梗死出现血流动力学不稳定。病理生理上，心包束缚和伴随的左心室功能障碍会加重右心室的收缩和舒张功能障碍，这解释了许多患者出现心源性休克和显著的前负荷依赖这一特征性表现。可根据临床表现、体格检查和酶学检查结果怀疑右心室梗死，并通过明确的心电图、放射性核素、超声心动图和血流动力学标准得以确诊。一旦确诊，右心室梗死需要特定的血流动力学和药物治疗，包括谨慎使用扩容和正性肌力支持。几种机械和外科干预形式对治疗血流动力学紊乱和公认的并发症具有治疗价值。通过适当的管理，右心室梗死患者的预后通常良好。
