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Right ventricular myocardial infarction: pathophysiology, diagnosis, and management
  1. Nicholaos Kakouros1,
  2. Dennis V Cokkinos2
  1. 1Interventional Cardiology Fellow, JohnsHopkins Hospital, Baltimore, Maryland, USA
  2. 2Biomedical Research Foundation of the Academy of Athens, Greece
  1. Correspondence to Dr Nicholaos Kakouros, Interventional Cardiology Fellow, Johns Hopkins University, Ross Research Building 1165/1167, 1721 East Madison Street, Baltimore, MD 21205, USA; nkakouros{at}


Right ventricular (RV) ischaemia complicates up to 50% of inferior myocardial infarctions (MIs), though isolated RV myocardial infarction (RVMI) is extremely rare. Although the RV shows good long term recovery, in the short term RV involvement portends a worse prognosis to uncomplicated inferior MI, with haemodynamic and electrophysiologic complications increasing in-hospital morbidity and mortality. Acute RV shock has an equally high mortality to left ventricular (LV) shock. Identification of RV involvement, particularly in the setting of hypotension, can help anticipate and prevent complications and has important management implications which are distinct from the management of patients presenting with LV infarction. Reperfusion therapy, particularly by primary percutaneous coronary intervention, hastens and enhances RV functional recovery that occurs to near normality in most patients. The diagnostic methods for RVMI are discussed, including clinical, electrocardiographic, and various imaging modalities as well as the RV pathophysiology that underpins the specifics of RVMI management.

  • Myocardial infarction/diagnosis
  • ventricular dysfunction-right
  • prognosis
  • echocardiography-methods
  • electrocardiography
  • accident & emergency medicine
  • ischaemic heart disease
  • cardiology

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.