Department of Cardiovascular Medicine, Beaumont University Hospital, Corewell Health, Royal Oak, Michigan, USA.
Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Am Coll Cardiol. 2024 May 7;83(18):1779-1798. doi: 10.1016/j.jacc.2023.09.839.
Right ventricular infarction (RVI) complicates 50% of cases of acute inferior ST-segment elevation myocardial infarction, and is associated with high in-hospital morbidity and mortality. Ischemic right ventricular (RV) systolic dysfunction decreases left ventricular preload delivery, resulting in low-output hypotension with clear lungs, and disproportionate right heart failure. RV systolic performance is generated by left ventricular contractile contributions mediated by the septum. Augmented right atrial contraction optimizes RV performance, whereas very proximal occlusions induce right atrial ischemia exacerbating hemodynamic compromise. RVI is associated with vagal mediated bradyarrhythmias, both during acute occlusion and abruptly with reperfusion. The ischemic dilated RV is also prone to malignant ventricular arrhythmias. Nevertheless, RV is remarkably resistant to infarction. Reperfusion facilitates RV recovery, even after prolonged occlusion and in patients with severe shock. However, in some cases hemodynamic compromise persists, necessitating pharmacological and mechanical circulatory support with dedicated RV assist devices as a "bridge to recovery."
右心室梗死（RVI）是急性下壁 ST 段抬高型心肌梗死的 50%并发症，与院内高发病率和死亡率相关。缺血性右心室（RV）收缩功能障碍降低左心室前负荷输送，导致低输出低血压而肺部清晰，并伴有不成比例的右心衰竭。RV 收缩性能由通过室间隔介导的左心室收缩贡献产生。增强右心房收缩可优化 RV 性能，而非常近端闭塞会引起右心房缺血，从而加重血流动力学障碍。RVI 与迷走神经介导的心动过缓相关，包括急性闭塞期间和再灌注期间。缺血性扩张的 RV 也容易发生恶性室性心律失常。然而，RV 对梗死具有很强的抵抗力。再灌注有助于 RV 恢复，即使在长时间闭塞和严重休克的患者中也是如此。然而，在某些情况下，血流动力学障碍持续存在，需要使用专门的 RV 辅助设备进行药理学和机械循环支持，作为“恢复的桥梁”。
