Published: 2019-01-23

Clinical profiling of right ventricular infarction in patients with acute inferior wall myocardial infarction

Vinod Khandait, Suresh Sarwale, Chandrashekhar Atkar, Harshwardhan Khandait


Background: Incidence of Right Ventricular Myocardial Infarction (RVMI) associated with Inferior Wall Myocardial Infarction (IWMI) is reported to be quite high (30%-50%). To diagnose coexisting RVMI is important, since its early recognition and proper treatment reduces overall morbidity and mortality in IWMI. Author assessed the incidence and clinically profiled patients with right ventricular infarction in acute inferior wall myocardial infarction and analysed the effects of RVMI on clinical outcome of IWMI.

Methods: A total of 150 patients of IWMI were evaluated in the present hospital based prospective observational study over duration of two years. They were evaluated for coronary risk factors like diabetes mellitus, hypertension, smoking, obesity, alcohol and dyslipidemia. Twelve-lead ECG, cardiac enzyme assay and echocardiography were undertaken in all the participants.

Results: Of the total 150 patients, 45 (30%) patients had right ventricular myocardial infarction (RVMI). Complications were significantly lower in patients with isolated IWMI as compared to patients with IWMI and associated RVMI except pulmonary edema (p<0.05). Of the total 22 (14.67%) deaths in the present study, 18 (12%) had associated RVMI and 4 (2.66%) isolated IWMI, the difference being statistically significant.

Conclusions: Involvement of right ventricle increases rate of complications as well as the mortality rate in patients with inferior wall myocardial infarction.


Inferior wall myocardial infarction, Right ventricular myocardial infarction

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Reddy KS, Shah B, Varghese C, Ramadoss A. Responding to the threat of chronic diseases in India. Lancet. 2005;366(9498):1744-9.

Institute of Health Metrics and Evaluation. GBD Profile: India, 2010. Available at: Accessed 30 September 2018.

Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al. Risk factors for early myocardial infarction in south Asians compared with individuals in other countries. JAMA. 2007;297(3):286-94.

Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. 2008;371(9622):1435-42.

WHO. World Heart Federation; World Stroke Organization. Global Atlas on Cardiovascular Disease Prevention and Control. Geneva, Switzerland; 2011. Available at:

Institute of Health Metrics and Evaluation. GBD Compare, 2010. Available at: Accessed 1 October 2018.

Joshi R, Cardona M, Iyengar S, Sukumar A, Raju CR, Raju KR, et al. Chronic diseases now a leading cause of death in rural India-mortality data from the Andhra Pradesh rural health initiative. Int J Epidemiol. 2006;35(6):1522-9.

Padmavati S. Epidemiology of cardiovascular disease in India: II. Ischemic heart disease. Circulation. 1962;25(4):711-7.

Gupta SP, Malhotra KC. Urban-rural trends in the epidemiology of coronary heart disease. J Assoc Physicians Ind. 1975;23(12):885-92.

Goldstein JA. Pathophysiology and management of right heart ischemia. J Am Coll Cardiol. 2002;40(5):841-53.

Khan S, Kundi A, Sharieff S. Prevalence of right ventricular myocardial infarction in patients with acute inferior wall myocardial infarction. Int J Clini Prac. 2004;58(4):354-7.

Kinch JW, Ryan TJ. Right ventricular infarction. Eng J Med. 1994;330(17):1211-7.

Thygesen K1, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Third universal definition of myocardial infarction. J Am Coll Cardiol. 2012;60:1581-98.

Cohn JN, Guiha NH, Broder MI, Limas CJ. Right ventricular infarction: clinical and hemodynamic features. Am J Cardiol. 1974;33(2):209-14.

Klein HO, Tordjman T, Ninio R, Sareli P, Oren V, Lang R, et al. The early recognition of right ventricular infarction: diagnostic accuracy of the electrocardiographic V4R lead. Circulation. 1983;67(3):558-65.

Chockalingam A, Gnanavelu G, Subramaniam T, Dorairajan S, Chockalingam V. Right ventricular myocardial infarction: presentation and acute outcomes. Angiol. 2005;56(4):371-6.

Iqbal A, Muddarangappa R, Shah SK, Vidyasagar S. A study of right ventricular infarction in inferior wall myocardial infarction. J Clin Sci Res. 2013;2:66-71.

Ravikeerthy M, Yogi SR. A study of right ventricular infarction in inferior wall myocardial infarction. Inter J Sci Res Pub. 2015;5(4):120-4.

Memon AG, Shah MI, Devrajani BR, Baloch S. Incidence of right ventricular infarction in patients with acute inferior wall infarction. J Postgrad Med Institute Pesh-Pak. 2015;29(3):189-92.

El Sebaie MH, El Khateeb O. Right ventricular echocardiographic parameters for prediction of proximal right coronary artery lesion in patients with inferior wall myocardial infarction. J Saudi Heart Assoc. 2016;28(2):73-80.

George S, Patel M, Thakkar A. Clinical profile and in-hospital outcome of patients with right ventricular myocardial infarction. Int J Clin Med. 2014;5(08):459-63.