Rodríguez MM

Language: Spanish
References: 12
Page: 407-411
PDF size: 174.12 Kb.

ABSTRACT

Acute RCA occlusion proximal to the RV branches results in RV free wall dysfunction. The ischemic dyskinetic RV free wall exerts mechanically disadvantageous effects on biventricular performance. Depressed RV systolic function leads to a diminished transpulmonary delivery of LV preload, resulting in reduced cardiac output. The ischemic RV is stiff, dilated, and volume-dependent, resulting in pandiastolic RV dysfunction and septally mediated alterations in LV compliance, exacerbated by elevated intrapericardial pressure. Under these conditions, RV pressure generation and output are dependent on LV septal contraction and paradoxic septal motion. Bradyarrhythmias limit the output generated by the rate-dependent ventricles. Ventricular arrhythmias are common, but do not impact short-term outcomes if mechanical reperfusion is prompt. Patients with RVI and hemodynamic instability often respond to volume resuscitation and restoration of physiologic rhythm. Vasodilators and diuretics should generally be avoided. In some patients, parenteral inotropes are required. The RV is resistant to infarction and usually recovers even after prolonged occlusion. However, prompt reperfusion enhances recovery of RV performance and improves the clinical course and survival of patients with ischemic RV dysfunction.

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