Recognition and Treatment of Right Ventricular Myocardial Infarction

     Supplemental oxygen is recommended, and aspirin may be given as usual. Beta-blockers and ACE inhibitors should be given with caution and only in accordance with local protocol in the setting of RVI.

     EMS providers play a special role in early diagnosis and proper treatment of any patient who is having a heart attack. By doing the right things, they can give the RVI patient a better chance for recovery.

Special thanks to Charles Krin, DO, for his advice and help in reviewing this article.

References

1. Moye S, Carney M, Holstege C, et al. The electrocardiogram in right ventricular myocardial infarction. Am J Emerg Med 23:793–799, 2005.

2. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation: Part I: Introduction to international guidelines 2000 for CPR and ECC: A consensus on science. Circulation 102(8 Suppl): 1–11, 2000.

3. Brainard A, Froman P, Alarcon M, et al. Physician attitudes about prehospital 12-lead ECGs in chest pain patients. Prehosp Disast Med 17(1):33–37, 2002.

4. Zehender M, Kasper W, Kauder E, et al. Eligibility for and benefit of thrombolytic therapy in inferior wall myocardial infarction: Focus on the prognostic importance of right ventricular infarction. J Am Coll Cardiol 24:362–369, 1994.

5. Moye S, op cit.

6. American Heart Association Guidelines for Advanced Cardiac Care, 2005.

7. Beasley R, Aldington S, Weatherall M, Robinson G. Oxygen therapy in myocardial infarction: An historical perspective. J R Soc Med 100:06–0065, 1–4, 2007.

8. American Heart Association Handbook of Emergency Cardiovascular Care, Guidelines CPR-ECC 2005, p. 59.

9. Markiewicz W, Finberg J, Lichtig C. Morphine increases myocardial infarction size in rats. Anesth Analog 61:843–846, 1982.

10. Hilfiker O, Larsen R, Brockschneider B, et al. Morphine in coronary blood flow and oxygen consumption in patients with coronary artery disease. Anesthes 31:371–376, 1982.

11. American Heart Association Handbook of Emergency Cardiovascular Care, Guidelines CPR-ECC 2005, p. 58.

12. Fuster V, et al. Hurst's The Heart, 11th ed., p. 1314–1316. New York, NY: McGraw-Hill Professional, 2004.

13. Horan LG, Flowers NC. Am Fam Phys 60:1721–1734, 1999.

14. Dalton R, Limmer D, Mistovich J, Werman H. Advanced Medical Life Support, 2nd ed., p. 205. Upper Saddle River, NJ: Prentice Hall, 2003.

15. Fuster V, op cit, p. 1315.

16. Horan LG, op cit, p. 1728.

17. Fuster V, op cit, p. 1315.

18. Tintinalli J, et al. Emergency Medicine, 6th ed. , p. 358. American College of Emergency Physicians, New York, NY: McGraw Hill Professional, 2004.

19. Martinez JA. Complications of acute myocardial infarction. Emergency Medicine, July 2003. www.emedmag.com/html/pre/cov/covers/071503.asp#top.

20. American Heart Association Handbook of Emergency Cardiovascular Care, Guidelines CPR-ECC 2005, p. 59.

William E. “Gene” Gandy, JD, LP, has been a paramedic and EMS educator for over 30 years. He has implemented a two-year associate’s degree paramedic program for a community college, served as both a volunteer and paid paramedic, and practiced in both rural and urban settings and in the offshore oil industry. He has testified in court as an expert witness in a number of cases involving EMS providers and lectures on medical/legal aspects of EMS. He lives in Tucson, AZ.