Hemodynamic compromise in right ventricular myocardial infarction does not strictly correlate with infarct size, highlighting the role of myocardial stunning.
THE CLASSIC morphological features of right ventricular myocardial infarction (RVMI) are illustrated in Fig 1. Necropsy observations1have established that RVMI is principally a complication of myocardial infarction involving the posterior (inferior) free wall of the left ventricle. Moreover, transmural infarction of the posterior ventricular septum is an additional prerequisite for RVMI. The extent of right ventricular free-wall involvement forms the basis for anatomic classification of RVMI (Fig 2).1,2Most cases of RVMI examined at necropsy are limited to the posterior right ventricular free wall. Analysis of RVMI by anatomic grades has disclosed that extensive RVMI is not required to express disturbed hemodynamics.1,2When profound hemodynamic alterations are observed in association with an anatomically small RVMI, eg, grade I, the discrepancy may be due to temporary stunning of the adjacent, noninfarcted portion of the right ventricular free wall (Fig 3). Thus, clinically dominant RVMI3does not
Jeffrey M. Isner (Fri,) studied this question.