Right ventricular infarction associated with anteroseptal myocardial infarction: A clinicopathologic study of nine cases

The association of right ventricular (RV) infarction with inferoseptal myoc ardial infarction is well established. However, a question remains about th e occurrence of RV infarction in association with anteroseptal myocardial i nfarction. To determine the frequency and clinical correlates of this entit y, we studied autopsied hearts from patients with isolated anteroseptal lef t ventricular (LV) infarcts. Among 3,249 autopsy specimens, 88 cases were i dentified. From each, sections were taken from the RV anterior, lateral, an d inferior regions at basal, middle, and apical levels. All 1,584 slides we re reviewed by blinded assessment. RV and LV infarcts were compared to conf irm similarity in age. Patient records and cardiac investigations were revi ewed for evidence of RV involvement. Of the 88 hearts with anteroseptal LV infarcts, 9 (10%) had coexistent RV infarction (6, old; 3, new). For these 9, the RV infarction involved 11% to 33% of the RV area, and the left anter ior descending coronary artery was the infarct-related artery in each. All 3 patients who had an echocardiographic examination within 4 weeks of anter oseptal LV infarction had RV dysfunction. One patient, studied 15 years aft er infarction, had a normal right ventricle by echocardiography. In 3 patie nts with acute myocardial infarction, right heart catheterization during th e acute phase revealed increased right-sided diastolic pressures out of pro portion to left-sided diastolic pressures (right atrial pressure to pulmona ry capillary wedge pressure, 60% to 95%). In conclusion, 10% of patients wi th an isolated anteroseptal LV infarct had evidence of RV free wall infarct ion. The RV infarction was associated with identifiable hemodynamic and ech ocardiographic features. Cardiovasc Pathol 2000;9:175-179 (C) 2000 by Elsev ier Science Inc.