ISOLATED RIGHT-VENTRICULAR INFARCTION

Our experience with 18 cases of isolated right ventricular infarction is reported and the literature is reviewed. Chronic lung disease with right ventricular hypertrophy is an important risk factor. Chest pain is the usual symptom at presentation but some cases can have breathles sness, palpitations or syncope. Some cases can have sinus bradycardia, atrial fibrillation or ventricular tachycardia. Atrioventricular bloc k is rare. Cases with pulmonary artery hypertension, extensive right v entricular infarction due to proximal occlusion of the right coronary artery, right atrial infarction or atrial fibrillation can have hypote nsion and/or systemic venous congestion. A surface electrocardiogram m ainly showing changes in leads conventionally considered to represent left ventricle and right-sided chest leads may not show an infarct pat tern in some cases. Echocardiography is, therefore, more reliable in d iagnosing this condition. The cautious use of small doses of nitrates and diuretics is not hazardous in the absence of hypotension. High dos es of steroids and anti-coagulants can be helpful. The prognosis is us ually good, although sudden collapse can occur due to ventricular fibr illation, rupture of the right ventricular free wall or a massive pulm onary embolism.