Clinical Study smokers. Out of 30 patients, 15 patients had RVMI and 15 patients had isolated IWMI. In this study, 19 patients had diabetes and 16 patients had hypertension. Of these 19 diabetics, seven patients had RVMI and 12 patients had inferior wall infarction without RVMI. Of the 16 hypertensives, six patients had RV infarction and 10 patients had inferior wall infarction without RV involvement. Hypotension was present in 25 patients (50%); 16 patients with RVMI had hypotension (80%). Six patients had bradycardia and jugular venous pressure (JVP) was raised in 25 patients. Five patients with RVMI had bradycardia (25%) and 16 patients with RVMI had increase JVP. In patients with RV infarction, RVS3 was noted in two patients and RVS4 in two patients. Complete heart block was present in six patients. Of those, five patients had RV infarction and one patient had IWMI without RV involvement. Incidence of complete heart block in patients with RV infarction in our study was 25%.
Cardiac Enzymes CPK-MB levels were raised in all patients with inferior wall infarction. In patients with RV infarction, it ranged from 68 to 116 IU/l with an average of 93.2 IU/l. In patients without RV infarction, it ranged from 62 to 128 IU/l with an average of 87.2.
Echocardiogram Of the 20 patients who had RV infarction, everyone showed hypokinesis of diaphragmatic wall of RV. Five patients showed RV dilatation and one showed tricuspid regurgitation. Among the 50 patients, 18 were thrombolyzed; of these, 12 did not have RV infarction and six had RV infarction. Fluid therapy was done in 13 patients with RV infarction. Amount of fluid varied from 1 to 2 liters of normal saline. There were eight deaths among the 50 study subjects. Of these eight deaths, five had RVMI and three had isolated IWMI. Discussion
60%
RV infarction
40%
Isolated IWMI
Figure 1.
Incidence of RVMI in acute IWMI varied from 5 to 43% in an autopsy series with a mean around 19%. Based on radionucleotide ventriculography of technetium pyrophosphate scintiography, Wacken et al found out the incidence of RV infarction in inferior wall infarction to be 37.5% and Braat et al found it to be 43%. In our study, the incidence of RV infarction in inferior wall was 40%, comparable with other results. There was no significant difference in the mean age in both groups of patients.
50
Isolated IWMI
40
RV infarction
30
20
10
0 1st degree heart block
Type 1 2nd degree Type 2 2nd degree heart block heart block
Figure 2.
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Asian Journal of Clinical Cardiology, Vol. 14, No. 12, April 2012
Complete heart block
VPC
Ventricular tachycardia