right ventricular infarction

Well, I don't want to write the paper for you, but think about where the RV pumps blood from, and to ... compared to the left ventricle. If the infarct is in the RV, then it won't be pumping right, so where will blood back up? what will be starved of blood?

Hope that helps.

i already included that in diagnostic testing as far as hemodynamics are concerned. im looking for help with what i will see physically during an examination. i will include ecg findings but that’s about all i have at this point. thanks for the input though

Here are some sites that I googled for you. E-medicine requires sign up but it is free, and one of my favorite sites to go to.

Medscape: Medscape Access

Right ventricular myocardial infarction

Right Ventricular Infarction

Right Ventricular Infarction EKG (ECG)

Try googling, there is A LOT of information out there on this subject.

And remember to cite your research! If you don't know how, google APA style writing.

Good Luck and have fun with it.

On right ventricular infarction. Keep in mind that vary rarely you will have an isolated RV infarction alone as generally the RCA is blocked and it provides blood for the inferior wall of the left ventricle as well.

But think of the RV as a "rubber band". It's not as thick as the left ventricle so it's pumping force is low (as it only has to pump into the pulmonary system as opposed to the entire body). Basically what happens during RV infarction is that your right side of the heart fails to pump enough blood onwards into the pulmonary circulation. The blood is "pooling" before the right ventricle so you have all the signs and symptoms of acute right sided decompensation (e.g. distended neck veins, stasis of blood in the liver, malleolary edema).

At the same time because your RV is failing you aren't transporting enough blood to the left ventricle. The LV fails to pump out enough blood (it isn't getting enough) and you'll become hypotensive. But in an isolated RV infarction your LV is not the defective ventricle and you won't see typical signs and symptoms of blood pooling before the LV (e.g. pulmonary edema).

This is why management of RV infarction is so different from LV infarction (the classic MI). The right side of the heart has little muscle as compared to the LV. So when treating a RV infarction you won't see good results with inotropes and vasodilators.

Vasodilators are normally something to help out the LV when it's pumping is failing because they decrease the afterload the LV is trying to pump against. But on the venous side they do the same thing they dilate the veins and the RV gets offered less blood because of this. But since the RV is kinda like a rubber band it needs enough blood to stretch the walls of the RV to pump out enough. If you want your rubber band to shoot further away you stretch it more. So typically these patients get more fluids despite distended neck veins in an attempt to stretch the RV wall further and have it contract more forcefully.

Inotropes drive up the myocardial oxygen use and tell the LV to pump better in a setting where it isn't getting enough blood to begin with so it won't really work. And the influence inotropes have on the RV are limited at best because of the relative low muscle mass. On top of that inotropes tend to increase the frequency of the heart. And we all now that the faster the heart pumps the less time there is for the ventricles to fill up.

So with RV infarction you want to give fluids to the patient even when the neck veins are distended (as long as they are not in pulmonary edema), you won't give vasodilators, you don't give diuretics, you won't give inotropes and you'll want a nice resting pulse rate to give the RV enough time to fill up.

Of course things are usually not as easy as it seems. Because many times you'll have RV and LV infarction and you and your clinician have to start conflicting treatments for both problems and hope that in the end it balances out and both the LV and RV function improve.

Hope this gets you started in searching for more information. I've been training a lot of newer nurses in my ICU and most people (even our ICU residents) find RV infarction something very strange to fully comprehend.

mayo clinic was a life saver in nursing school.