Right Ventricular Myocardial Infarction: it´s Incidence, Clinical, Laboratory, ECG and ECHO Characteristics in Riga East Clinical University Hospital in Year 2018
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Labā kambara miokarda infarkts ir reti sastopams kā izolēts infarkts, bet bieži vien pavada kreisā kambara apakšējās sienas miokarda infarktu (MI). Labais kambaris (LK) ir izturīgāks pret išēmiju, salīdzinot ar kreiso kambari.
Šī pētījuma mērķis ir novērtēt LKMI sastopamību miokarda infarkta ar ST segmenta elevāciju (STEMI) pacientu vidū un raksturot LKMI raksturīgās īpašības Rīgas Austrumu klīniskās universitātes slimnīcā (RAKUS) pēc EKG, ehokardiogrāfijas un laboratorijas vērtībām 2018.gadā. Šī pētījuma uzdevums ir arī noteikt LKMI izraisīto komplikāciju biežumu pētāmajā pacientu grupā.
LKMI sastopamība pētījuma grupā bija augsta: 25% (25/100) STEMI pacientiem ehokardiogrāfijas izmeklējumā bija konstatētas LK globālas vai segmentālas sistoliskās disfunkcijas pazīmes. Pētījuma pacientu grupā 39% LKMI gadījumos 12-novadījumu EKG netika reģistrētas LKMI indikatīvas pazīmes, kas liecina par zemu 12-novadījumu EKG efektivitāti LKMI diagnostikā. Paplašinātas 15-novadījumu EKG ar labo krūšu novadījumu reģistrāciju ieviešana ir nepieciešama, lai uzlabotu LKMI agrīno diagnostiku.
Right ventricular myocardial infarction (RVMI) rarely occurs alone as isolated infarction but often accompanies inferior or anterior myocardial infarction. Right ventricle involvement in the myocardial infarct increases the risk of hemodynamic collapse, and the mortality is higher when left ventricular myocardial infarction occurs together with RVMI. Left-sided ECG and difficulties in visualizing right ventricle free wall by ECHO make its recognition challenging. This study aims to evaluate the high incidence of RVMI among STEMI patients and characterize typical characteristics of RVMI in Riga East Clinical University hospital by ECG, ECHO, and laboratory values as well as evaluate the incidence of rhythm-, and conduction disturbances arising from the RVMI. In the literature review part, the RVMI from the presentation to outcomes is described. In this study following results were obtained: RVMI incidence is high, 25% in the study group. Twelve-lead ECG did not show any signs indicatory for RVMI signs in 39% of RVMI cases, suggesting low efficacy of 12-lead ECG in the diagnostics of RVMI. Rhythm-, and conduction disturbances are common among RVMI patients, occurring in 72% of the studied population. Laboratory values indicatory for liver and kidney damage tend to be higher, suspecting concomitant acute organ dysfunction due to RV failure. Early recognition of the RV involvement in the myocardial infarction was missed in the study patients’ group. Implementation of extended 15-lead ECG with right precordial leads recording is necessary for RVMI early diagnostics improvement.
Right ventricular myocardial infarction (RVMI) rarely occurs alone as isolated infarction but often accompanies inferior or anterior myocardial infarction. Right ventricle involvement in the myocardial infarct increases the risk of hemodynamic collapse, and the mortality is higher when left ventricular myocardial infarction occurs together with RVMI. Left-sided ECG and difficulties in visualizing right ventricle free wall by ECHO make its recognition challenging. This study aims to evaluate the high incidence of RVMI among STEMI patients and characterize typical characteristics of RVMI in Riga East Clinical University hospital by ECG, ECHO, and laboratory values as well as evaluate the incidence of rhythm-, and conduction disturbances arising from the RVMI. In the literature review part, the RVMI from the presentation to outcomes is described. In this study following results were obtained: RVMI incidence is high, 25% in the study group. Twelve-lead ECG did not show any signs indicatory for RVMI signs in 39% of RVMI cases, suggesting low efficacy of 12-lead ECG in the diagnostics of RVMI. Rhythm-, and conduction disturbances are common among RVMI patients, occurring in 72% of the studied population. Laboratory values indicatory for liver and kidney damage tend to be higher, suspecting concomitant acute organ dysfunction due to RV failure. Early recognition of the RV involvement in the myocardial infarction was missed in the study patients’ group. Implementation of extended 15-lead ECG with right precordial leads recording is necessary for RVMI early diagnostics improvement.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Labā Kambara Miokarda Infarkts, EKG, Ehokardiogrāfija, Vainīgā Artērija, Bradikardija, AV blokāde, Right ventricular myocardial infarction, extended ECG, Right Precordial Leads, Culprit artery, bradycardia, AV-block, Tricuspid Annular Plane Systolic Excursion, Derived Tricuspid Lateral Annular Systolic Velocity, Fraction area change, IVC Diameter, Right Ventricular Systolic Dysfunction