To Study the Echocardiographic and Heamodynamic Parameters of Right Heart in Patients with Acute Inferior Wall Myocardial Infarction and Its Angiographic Correlation

Abstract

The right ventricle, a physically and functionally complex chamber, is responsible for pushing venous blood out of the right atrium and back into the lungs via the pulmonary artery. A number of clinical disorders, including inferior wall myocardial infarction, are related to right ventricular function. Most patients with inferior wall myocardial infarction, at least one-third of them, have right ventricular dysfunction. When right ventricular dysfunction coexists with inferior wall myocardial infarction (IWMI), the mortality rate is much higher1. When there is a relative contraindication for thrombolysis [2], evaluation of right ventricular function is also clinically significant. In the absence of right ventricular involvement, thrombolysis provided little benefit for individuals with inferior wall myocardial infarction, according to a research by Zehender et al. As a result, the diagnosis and evaluation of RV function are crucial in IWMI. Right ventricular myocardial infarction (RVMI) complicates inferior wall myocardial infarction in as many as 50% of patients. The location of the myocardial infarction (MI), which occurs more frequently in the inferior wall and accounts for 24% to 50% of cases, is the main factor determining the likelihood of right ventricular (RV) dysfunction³ . Even though right ventricular infarction is clinically visible in a significant percentage of instances, the incidence is significantly lower than that discovered at autopsy [4]. The challenge in diagnosing right ventricular myocardial infarction in patients who are still alive is one of the main causes of the difference. It is especially harder to estimate the true incidence of right ventricular dysfunction and stunning since they typically have a transitory nature. There are criteria for diagnosing RVMI, however even when strictly followed, they underestimate the true prevalence of right ventricular infarction. In contrast to other clinical factors that were known at the time of admission, RVMI is linked to a “relative risk of in-hospital mortality of 7.7 (95% CI)” and “a risk of significant in-hospital complications of 4.7 (95% CI)” [5]. The affected patient is exceptionally vulnerable to decreased preload and loss of atrioventricular synchronisation due to the probable hemodynamic disturbances associated with right ventricular infarction. These two conditions may cause a significant reduction in right and, secondly, left ventricular output [6]. In individuals with right ventricular dilatation, “cardiogenic shock” and the need for “transvenous cardiac pacing” are more frequent. Furthermore, regardless of where the infarct occurs, the presence of “right ventricular dysfunction” carries a poor prognosis since it suggests “multivessel coronary artery disease”. “Right ventricular dysfunction” must be demonstrated since it frequently coexists with a discrete clinical condition that necessitates particular treatment. The “therapeutic implications of separating individuals” with “right ventricular dysfunction” from those without right ventricular dysfunction have increased interest in identifying right ventricular involvement non-invasively. It is difficult to assess the right ventricle's size and function because of its more complex architecture and mechanics. Anterior, inferior, and lateral (free) walls make up the RV's triangular hollow. Its three anatomy sections are “the inflow, apex, and outflow tract (RVOT). The parasternal short axis (PSAX) of the RV, which envelops the Left Ventricle (LV)”, is shaped like a crescent. The RV endocardium is harder to define because to its thinner walls than the LV and its conspicuous trabeculations. And occasionally, the retrosternal position reduces the resolution of ultrasound waves.