Right Ventricular Myocardial Infarction: Pathophysiology, Diagnosis, and Therapeutic Approaches

Right ventricular myocardial infarction (RVMI) is a significant and distinct form of acute myocardial infarction associated with considerable morbidity and mortality. It occurs most commonly due to proximal right coronary artery obstruction, often in conjunction with inferior myocardial infarction. RVMI poses unique diagnostic and therapeutic challenges due to the anatomical and functional differences between the right and left ventricles. Key clinical manifestations include symptoms of right-sided heart failure, such as hypotension, jugular venous distention, and peripheral edema. The pathophysiology of RVMI involves impaired right ventricular (RV) function, decreased cardiac output, and poor hemodynamic stability, often leading to cardiogenic shock. Diagnostic tools, including 12-lead electrocardiography, echocardiography, cardiac magnetic resonance imaging, and coronary angiography, play crucial roles in detecting RVMI and determining its severity. Treatment strategies focus on early revascularization through primary percutaneous coronary intervention or thrombolysis, maintaining adequate RV preload, and managing arrhythmias and hemodynamic instability. In severe cases, mechanical circulatory support, such as intra-aortic balloon pumps and extracorporeal membrane oxygenation, may be required. Despite advancements in imaging and therapeutic approaches, RVMI remains a complex condition that demands timely and specialized management to improve patient outcomes. Further research is needed to refine diagnostic and treatment strategies and to reduce the high mortality rates associated with this condition.