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. 1991 Feb;65(2):63–67. doi: 10.1136/hrt.65.2.63

Mechanism of shock associated with right ventricular infarction.

J E Creamer 1, J D Edwards 1, P Nightingale 1
PMCID: PMC1024492  PMID: 1867948

Abstract

Various mechanisms have been proposed to explain the shock sometimes associated with right ventricular infarction, but only small numbers of patients with clinical shock have been studied. The haemodynamic profiles of seven patients with clinical cardiogenic shock after right ventricular myocardial infarction were studied prospectively. They were selected because all had a stable cardiac rhythm and none had absolute hypovolaemia during the study period. In all of them the mean right atrial pressure exceeded the pulmonary artery occlusion pressure. After treatment with varying combinations of dopamine, dobutamine, and glyceryl trinitrate (titrated to achieve the optimum haemodynamic response) the mean systemic arterial pressure increased, as did the cardiac index. There was an associated increase in the left ventricular stroke work index but the right ventricular stroke work index was unchanged. There was no significant change in heart rate, mean right atrial pressure, or pulmonary artery occlusion pressure. This suggests that the probable mechanism of the shock associated with right ventricular infarction is concomitant severe left ventricular dysfunction.

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Selected References

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  1. Berisha S., Kastrati A., Goda A., Popa Y. Optimal value of filling pressure in the right side of the heart in acute right ventricular infarction. Br Heart J. 1990 Feb;63(2):98–102. doi: 10.1136/hrt.63.2.98. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Cintron G. B., Hernandez E., Linares E., Aranda J. M. Bedside recognition, incidence and clinical course of right ventricular infarction. Am J Cardiol. 1981 Feb;47(2):224–227. doi: 10.1016/0002-9149(81)90389-1. [DOI] [PubMed] [Google Scholar]
  3. Cohn J. N., Guiha N. H., Broder M. I., Limas C. J. Right ventricular infarction. Clinical and hemodynamic features. Am J Cardiol. 1974 Feb;33(2):209–214. doi: 10.1016/0002-9149(74)90276-8. [DOI] [PubMed] [Google Scholar]
  4. Come P. C., Pitt B. Nitroglycerin-induced severe hypotension and bradycardia in patients with acute myocardial infarction. Circulation. 1976 Oct;54(4):624–628. doi: 10.1161/01.cir.54.4.624. [DOI] [PubMed] [Google Scholar]
  5. Creamer J. E., Edwards J. D., Nightingale P. Hemodynamic and oxygen transport variables in cardiogenic shock secondary to acute myocardial infarction, and response to treatment. Am J Cardiol. 1990 Jun 1;65(20):1297–1300. doi: 10.1016/0002-9149(90)91316-x. [DOI] [PubMed] [Google Scholar]
  6. Crexells C., Chatterjee K., Forrester J. S., Dikshit K., Swan H. J. Optimal level of filling pressure in the left side of the heart in acute myocardial infarction. N Engl J Med. 1973 Dec 13;289(24):1263–1266. doi: 10.1056/NEJM197312132892401. [DOI] [PubMed] [Google Scholar]
  7. Dell'Italia L. J., Starling M. R., Crawford M. H., Boros B. L., Chaudhuri T. K., O'Rourke R. A. Right ventricular infarction: identification by hemodynamic measurements before and after volume loading and correlation with noninvasive techniques. J Am Coll Cardiol. 1984 Nov;4(5):931–939. doi: 10.1016/s0735-1097(84)80053-4. [DOI] [PubMed] [Google Scholar]
  8. Edwards D., Whittaker S., Prior A. Cardiogenic shock without a critically raised left ventricular end diastolic pressure: management and outcome in eighteen patients. Br Heart J. 1986 Jun;55(6):549–553. doi: 10.1136/hrt.55.6.549. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Forrester J. S., Diamond G., Chatterjee K., Swan H. J. Medical therapy of acute myocardial infarction by application of hemodynamic subsets (first of two parts). N Engl J Med. 1976 Dec 9;295(24):1356–1362. doi: 10.1056/NEJM197612092952406. [DOI] [PubMed] [Google Scholar]
  10. Gewirtz H., Gold H. K., Fallon J. T., Pasternak R. C., Leinbach R. C. Role of right ventricular infarction in cardiogenic shock associated with inferior myocardial infarction. Br Heart J. 1979 Dec;42(6):719–725. doi: 10.1136/hrt.42.6.719. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Goldstein J. A., Vlahakes G. J., Verrier E. D., Schiller N. B., Botvinick E., Tyberg J. V., Parmley W. W., Chatterjee K. Volume loading improves low cardiac output in experimental right ventricular infarction. J Am Coll Cardiol. 1983 Aug;2(2):270–278. doi: 10.1016/s0735-1097(83)80163-6. [DOI] [PubMed] [Google Scholar]
  12. Isner J. M. Right ventricular myocardial infarction. JAMA. 1988 Feb 5;259(5):712–718. doi: 10.1001/jama.259.5.712. [DOI] [PubMed] [Google Scholar]
  13. Lloyd E. A., Gersh B. J., Kennelly B. M. Hemodynamic spectrum of "'dominant" right ventricular infarction in 19 patients. Am J Cardiol. 1981 Dec;48(6):1016–1022. doi: 10.1016/0002-9149(81)90314-3. [DOI] [PubMed] [Google Scholar]
  14. Lorell B., Leinbach R. C., Pohost G. M., Gold H. K., Dinsmore R. E., Hutter A. M., Jr, Pastore J. O., Desanctis R. W. Right ventricular infarction. Clinical diagnosis and differentiation from cardiac tamponade and pericardial constriction. Am J Cardiol. 1979 Mar;43(3):465–471. doi: 10.1016/0002-9149(79)90001-8. [DOI] [PubMed] [Google Scholar]
  15. Love J. C., Haffajee C. I., Gore J. M., Alpert J. S. Reversibility of hypotension and shock by atrial or atrioventricular sequential pacing in patients with right ventricular infarction. Am Heart J. 1984 Jul;108(1):5–13. doi: 10.1016/0002-8703(84)90537-4. [DOI] [PubMed] [Google Scholar]
  16. Moore C. A., Nygaard T. W., Kaiser D. L., Cooper A. A., Gibson R. S. Postinfarction ventricular septal rupture: the importance of location of infarction and right ventricular function in determining survival. Circulation. 1986 Jul;74(1):45–55. doi: 10.1161/01.cir.74.1.45. [DOI] [PubMed] [Google Scholar]
  17. Rackley C. E., Russell R. O., Jr, Mantle J. A., Rogers W. J., Papapietro S. E., Schwartz K. M. Right ventricular infarction and function. Am Heart J. 1981 Feb;101(2):215–218. doi: 10.1016/0002-8703(81)90668-2. [DOI] [PubMed] [Google Scholar]
  18. Rigo P., Murray M., Taylor D. R., Weisfeldt M. L., Kelly D. T., Strauss H. W., Pitt B. Right ventricular dysfunction detected by gated scintiphotography in patients with acute inferior myocardial infarction. Circulation. 1975 Aug;52(2):268–274. doi: 10.1161/01.cir.52.2.268. [DOI] [PubMed] [Google Scholar]
  19. Russell R. O., Jr, Rackley C. E., Pombo J., Hunt D., Potanin C., Dodge H. T. Effects of increasing left ventricular filling. Pressure in patients with acute myocardial infarction. J Clin Invest. 1970 Aug;49(8):1539–1550. doi: 10.1172/JCI106371. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Scheidt S., Ascheim R., Killip T., 3rd Shock after acute myocardial infarction. A clinical and hemodynamic profile. Am J Cardiol. 1970 Dec;26(6):556–564. doi: 10.1016/0002-9149(70)90407-8. [DOI] [PubMed] [Google Scholar]
  21. Sharpe D. N., Botvinick E. H., Shames D. M., Schiller N. B., Massie B. M., Chatterjee K., Parmley W. W. The noninvasive diagnosis of right ventricular infarction. Circulation. 1978 Mar;57(3):483–490. doi: 10.1161/01.cir.57.3.483. [DOI] [PubMed] [Google Scholar]
  22. Shoemaker W. C. Relation of oxygen transport patterns to the pathophysiology and therapy of shock states. Intensive Care Med. 1987;13(4):230–243. doi: 10.1007/BF00265111. [DOI] [PubMed] [Google Scholar]
  23. Tobinick E., Schelbert H. R., Henning H., LeWinter M., Taylor A., Ashburn W. L., Karliner J. S. Right ventricular ejection fraction in patients with acute anterior and inferior myocardial infarction assessed by radionuclide angiography. Circulation. 1978 Jun;57(6):1078–1084. doi: 10.1161/01.cir.57.6.1078. [DOI] [PubMed] [Google Scholar]
  24. Vecht R. J., Carmichael D. J., Gopal R., Philip G. Uhl's anomaly. Br Heart J. 1979 Jun;41(6):676–682. doi: 10.1136/hrt.41.6.676. [DOI] [PMC free article] [PubMed] [Google Scholar]

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