Right Ventricular Infarction - Causes, Symptoms, Diagnosis, and Treatment

Introduction

The heart has four chambers- two upper sections called the right and left atrium and two lower sections called the right and left ventricles. Parallel to four chambers, the heart has four valves- mitral valve, tricuspid valve, aortic valve, and pulmonary valve. Valves are a crucial part of the heart’s structure. They open and close as the blood passes through them. They mainly regulate the entry and exit of blood into the heart’s various chambers. The valves have flaps or leaflets that open and close. Valves with three leaflets open and close simultaneously. In order to avoid any sort of backflow of blood, the leaflets close, and vice verse is why they open.

Myocardial infarction or a heart attack is an exceedingly life-threatening condition where there is an acute absence of blood flow to the muscles of the heart. When the myocardial infarction occurs in the right ventricles, it leads to an uncommon and rare right ventricular infarction. Right ventricular infarction is also called RVMI- right ventricular myocardial infarction and is linked to higher death rates.

What Are the Causes of Right Ventricular Infarction?

The causes of right ventricular infarction may not appear immediately. There have been several causes of right ventricular infarction, such as ongoing and long-standing disturbances of the rhythm of the heart. Lifestyle activities and being less physical are given immense credit for being one of the leading causes of right ventricular infarctions. Mentioned below are a few of the etiological factors behind the development of right ventricular infarction.

• Ventricular tachycardia.

• Heart block.

• Spasms of the heart's arteries can twitch and cut off the blood flow to the heart muscles.

• Atypical narrowing of the heart's blood vessels due to a rare medical disease.

• Trauma that ruptures the heart.

• An embolism or obstruction.

• Abnormalities with the levels of potassium in the blood.

• Overeating.

• Atrial fibrillation (irregular and rapid electrical signals in the atria, leading to an irregular heartbeat).

• Influenza (a highly contagious viral respiratory illness that causes symptoms such as fever, cough, body aches, and fatigue).

• Cardiac scarring (formation of fibrous tissue in the heart as a result of injury or damage).

What Are the Signs And Symptoms of Right Ventricular Infarction?

Every individual may not show all the classical signs of myocardial infarction. A right ventricular infarction is presented with several clinical manifestations that may vary between individuals depending upon numerous factors such as the underlying cause of the infarct, genetic background, lifestyle habits, etc. Mentioned below are a few of the signs and symptoms experienced by the majority of patients who may have experienced an episode of right ventricular infarction.

• Sweating.

• Pale skin.

• Cool hands and feet.

• Shortness of breath.

• Chest pain that gets worse over time.

• Severe pressure on the chest.

• A feeling of fullness.

• Pain and squeezing sensation in the chest.

• Discomfort or pain in the middle of the chest remains for a few minutes and then returns.

• Discomfort or pain that reaches the left shoulder or both shoulders.

• Discomfort or pain spreads to the left arm and jaws or both arms and jaws.

• Pain or tightness in the neck.

• Bloating.

• Nausea.

• Vomiting.

• Dizziness.

• Fainting.

• Fatigues.

• Lightheadedness.

• Weakness.

• Rapid pulse.

• Unexplained wheezing.

• Anxiety.

• Stomach pain.

• Severe crushing, like chest pain.

• Insomnia (sleeplessness).

• Malaise.

How to Diagnose Right Ventricular Infarction?

Many laboratory tests and investigations are used to diagnose and conclude a right myocardial infarction. There have been numerous advances in the field of cardiovascular investigations that may be both sensitive as well as quick. Mentioned below are a few diagnostic tools that may aid in diagnosing and determining the cause and presence of right ventricular infarction.

• Cardiac biomarkers.

• Cardiac enzymes.

• Tests for troponin levels.

• Complete blood picture.

• Lipid profile evaluation.

• Complete metabolic panel.

• Electrocardiography.

• Cardiac imaging.

• Chest x-rays.

• Transcatheter echocardiography.

• Myocardial perfusion imaging.

• SPECT (single-photon emission computed tomography) with thallium.

• PET (positron-emission tomography) scan.

• MIBI (methoxy isobutyl isonitrile) scan.

What Is the Treatment of Right Ventricular Infarction?

The first line of treatment is to restore the vital signs and keep them under constant monitoring. Pain relief and any sort of blood clots that may be preventing the blood from entering or exiting the heart must be immediately cleared. The oxygen saturation levels of the patients must be continually maintained. Non-enteric-coated-chewable Aspirin tablets may additionally be provided. Sodium nitroglycerine may be placed under the tongue, though it does not prove to be of any benefit, and this is one of the classical signs of a right ventricular infarction. The patients undergo treatment, invasive or non-invasive, depending on the presence of any underlying disease as well as the etiological factor behind the development and occurrence of right ventricular infarction. Mentioned below are a few of the treatment modalities and management plans that may be executed during right ventricular infarction.

• Unblocking the blood vessels.

• Reducing the ischemia.

• Thrombolysis coronary intervention.

• Percutaneous coronary intervention.

• Vasodilator.

• Opioid medication.

• Antiplatelet drug medication.

• P2Y12 inhibitors.

• Heparin.

• Platelet glycoprotein GpIIb/IIIa inhibitor.

• Coronary artery bypass grafting.

• Fibrinolysis.

• Aldosterone antagonist.

• Targeted temperature management.

• Cardiac rehabilitation.

Who Are At Risk of Developing Right Ventricular Infarction and How to Prevent It?

Patients who are obese and have a family history of heart attacks are the potential candidates to develop right ventricular infarction in the future. Eating a diet rich in cholesterol and other deep-fried foods is known to cause plaque deposition within the heart and lead to blockage. Being active and living a heart-healthy lifestyle is key to preventing an episode of right ventricular infarctions.

Conclusion

Right ventricular infarction is a heart attack that occurs only in the right ventricular chamber of the heart. It is extremely rare and quite fatal if not treated promptly. There are several diagnostic tools along with clinical manifestations that may heal the healthcare provider and team to understand the undergoing condition of the patient. Advanced lab tests and radiological studies aid in diagnosis as well. The treatment is possible, provided it is conducted as early as possible. Medication therapy, as well as invasive treatment options such as surgical correction, may be possible but at a later stage.