Right ventricular infarction (RVI) is a life-threatening complication of inferior ST-elevation myocardial infarction (STEMI), occurring in approximately 30–50% of such cases—typically when the proximal right coronary artery (RCA) is occluded 1,2. While left ventricular (LV) infarction receives more clinical focus, RVI significantly worsens patient outcomes and is often underdiagnosed due to nonspecific signs 3,4. The right ventricle (RV) is anatomically distinct from the LV, with a thinner free wall, lower systolic pressure, and greater dependence on preload. These characteristics make the RV highly susceptible to ischemic damage and volume depletion. RV dysfunction can compromise left-sided output due to interventricular dependence, thereby leading to systemic hypotension and cardiogenic shock 5,6. Although timely revascularization is the cornerstone of STEMI therapy, standard management strategies may be inadequate in dominant RVI. In such cases, mechanical support such as right ventricular assist devices (RVADs) or extracorporeal membrane oxygenation (ECMO) can be lifesaving. Unfortunately, these are not universally accessible, particularly in resource-limited settings 7. We present a case of inferior STEMI with RVI, highlighting the limitations of current management and the impact of unavailable mechanical RV support.
Hosseini et al. (Mon,) studied this question.