Right guide SH Sian and Sian blue wires to RCA and RV branch Pre dilated with Emerge balloon dilation catheter 2.5x20mm Promus PREMIER™ Everolimus- Eluting Platinum Chromium Coronary Stent placed in main RCA Post dilated with kissing balloons for RV branch protection
Sanders AO. Coronary thrombosis with complete heart-block and relative ventricular tachycardia: a case report. Am Heart J 1930;6:820-823
Malignant ventricular arrhythmias occurred in up to 38% of patients and tended to be associated with larger infarct size (measured by peak CPK). Concomitant RVMI occurs in 30–50% of cases of patients with acute inferior MI Isolated right ventricular infarction accounts for less than 3% of all cases of infarction. Ricci, S.R. Dukkipati, M.C. Pica, D.E. Haines, J.A. Goldstein Malignant ventricular arrhythmias in patients with acute right ventricular infarction undergoing mechanical reperfusion Am J Cardiol, 104 (12) (2009), pp. 1678–1683 Andersen HR, Falk E, Nielsen D. Right ventricular infarction: frequency, size and topography in coronary heart disease: a prospective study comprising 107 consecutive autopsies from a coronary care unit. J Am Coll Cardiol 1987;10:1223-1232AJ.M.
DE-CMR more sensitively identifies RVMI in patients presenting with acute inferior MI than ECG physical exam echocardiography A. Kumar, H. Abdel-Aty, I. Kriedemann, J. Schulz-Menger, C.M. Gross, R. Dietz, M.G. Friedrich Contrast-enhanced cardiovascular magnetic resonance imaging of right ventricular infarction J Am Coll Cardiol, 48 (10) (2006), pp. 1969– 1976
Isolated RVMI relatively rare presentation Non-Dominant RCA lesions not benign & innocuous Value of CMRI Limited data on value of AICD
Kinch JW, Ryan TJ. Right ventricular infarction. N Engl J Med. 1994;330:1211–1217. Haji SA, Movahed A. Right ventricular infarction-diagnosis and treatment. Clin Cardiol. 2000;23:473–482. A. Kumar, H. Abdel-Aty, I. Kriedemann, J. Schulz-Menger, C.M. Gross, R. Dietz, M.G. FriedrichContrast-enhanced cardiovascular magnetic resonance imaging of right ventricular infarction J Am Coll Cardiol, 48 (10) (2006), pp. 1969–1976 Cavalcante JL, Al-Mallah M, Hudson M. Isolated right ventricular infarct presenting as ventricular fibrillation arrest and confirmed by delayed-enhancement cardiac MRI. Heart Lung Circ 2010; 19: 620-623. Hurst JW, editor. The heart, 4th ed. New York: McGraw- Hill; 1978. p 409
LV: normal size, volume, function. RV: increased ESV & hypokinesis of the inferior & anterior walls at the base & mid segments with mildly reduced global systolic function, EF 40% Perfusion: Evidence of matched/fixed perfusion defects in septum & inferoseptum from mid wall to base Tissue: mild oedema in basal segments of the RV anterior & inferior wall on dark blood T2 weighted STIR images. DE- abnormal signal in basal & mid segments of inferior and anterior wall of RV, indication infarction.