rupesh george



Background: Right ventricular(RV) dysfunction predicts poor prognosis in acute myocardial infarction. The sensitivity of clinical findings for RVMI is as low as 10%. Right side ECG leads give information of right ventricular free wall only. As Tissue Doppler study of  RV gives better information of global RV function we intended to do this study.


Objectives: The present study was conducted to investigate the effect of different infarction sites on right ventricular (RV) functional changes by echocardiogram in patients with first acute ST-elevation myocardial infarction.


Methodology: The study was a descriptive cross sectional study with the study setting from the In-patients of the departments of internal medicine and cardiology. Clinical findings and echocardiography of  consecutive 200 patients with myocardial infarction during the period of Dec 2012 to Dec 2013, who met the inclusion and exclusion criteria, were taken. Age, gender distribution, risk factors, clinical findings, ECG and Echocardiographic findings including, TAPSE, Tissue Doppler MPI, ejection fraction were analysed.


Results: The prevalence of RV dysfunction in echo cardiogram was comparable in both AWMI and IWMI. In our study 30.3% (n= 27) had abnormal TAPSE in AWMI and 34.2% (n = 38) in IWMI. Tissue Doppler MPI abnormality was seen in 34 patients (38.2%) with Anterior Wall MI and 55 patients (49.5%) with inferior wall MI. Impairment of  LV Ejection fraction was more frequent in AWMI (84.3%{ n = 75 } ) than in IWMI (18.9%).


Conclusion: Even though, clinical RV involvement was more in cases of inferior wall myocardial infarction, echocardiographically, the incidence was comparable in  both inferior wall MI and anterior wall MI.


Key Words:  RV  function , myocardial infarction, TAPSE , Tissue Doppler MPI.




Full Text:



Guiha NH, Limas CJ, Cohn JN.Predominant RV dysfunction after experimentalRV destruction. Am J Cardiol 1974; 33:254.

Cohn JN, Guiha NH, Broder MI, LimasY.Right ventricular infarction, clinical and hemodynamic features. Am J Cardiol 197; 33:209-214.

Chou TC, Bel VD, Khan J, Allen J, Brockmeier L, Fowler NO. Electrocardiographic diagnosis of right ventricular infarction. Am J Med 1981;70:1175-1180

Morgera T, Alberti E, Silvestri F, Pandullo C, Della mea MT, Camerini F. Right precordial ST and QRS changes in the diagnosis of right ventricular infarction.Am Heart J 1984; 108:13-18.

Standring S, Johnson D, Shah P. Heart and Great vessels.Gray’sAnatomy.The anatomical basis of clinical practice 39th edition. Elsevier Churchill Livingstone 2005; 997-101

Forman MB, Goodin J, Phelan B, Kopelman H, Virmani R. Electrocardiographic changes associated with isolated right ventricular infarction. J Am CollCardiol 1984;4:640-3.

Weyman A. Practices and principles of echocardiography. 2nd ed. Philadelphia: Lippincott, Williams and Wilkins; 1994.

Kaul U, Dogra B, Manchanda SC et al. Myocardial infarction in young Indian patients: Risk factors and coronary arteriographic profile. Am H J 1998; 112 (1): 71-5.

Uhl GS, Farrell PW. Myocardial infraction in young adults: Risk factors and natural history. Am H J 1983; 105: 584.

Multani AS, Neki NS, Khurana A, Sikri T. Clinical and electrocardiographic profile of RVI in acute inferior wall myocardial infarction.JAPI Jan 2001; vol 49:182.

Sharma C, Nagpal GS, Nagpal HK. Clinical and angiographic profile of coronary artery disease in Western Punjab. Indian Heart J 2005; 57:543-554.

Kanitz MG, Giovannucci SJ, Jones JS, Mott M. Myocardial infarction in young adults: Risks factors and clinical features. Journal of Emergency Med 1999;14:139-145.

S.R. Mittal, S. Garg, M. Lalgarhia . Jugular venous pressure and pulse wave form in the diagnosis of right ventricular infarction Int J Cardiol, 53 (3) (1996), pp. 253–256

H.G. Hayrapetyan , K.G. Adamyan ,Erebouni MC, Yerevan, Armenia; Instituteof Cardiology, Yerevan, Armenia. Prognostic usefulness of the tricuspid annular plane systolic excursion in patients with acute inferior myocardial infarction.

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography. J Am SocEchocardiogr 2010;23:685-713.

SerdarBayata, EyüpAvcı, Murat Yeşil, ErdinçArıkan, NursenPostacı, SelcenYakarTülüce. Clinic of 1st Cardiology, Atatürk Education and Research Hospital, İzmir-Turkey ; Tricuspid annular motion in right coronary artery-related acute inferior myocardial infarction with or without right ventricular involvement

Mehmet Ata Akl ,FarukErta, Hasan Kaya, Mehmet ZihniBilik ; Comparison of right ventricular functions according to infarct localization using advanced echocardiographic methods in myocardial infarction with ST elevation. Dicle Medical Journal 2012; 39 (4): 561-566

Dokainish H., Abbey H., Gin K. Usefulness of tissue Doppler imaging in the diagnosis and prognosis of acute right ventricular infarction with inferior wall acute left ventricular infarction.Am J Cardiol. 2005;95:1039–1042.

Karnati P.K., El-Hajjar M., Torosoff M. Myocardial performance index correlates with right ventricular ejection fraction measured by nuclear ventriculography. Echocardiography. 2008;25:381–385

N. Kakouros, S. Kakouros, J. Lekakis, I. Rizos, D. Cokkinos. Tissue Doppler imaging of the tricuspid annulus and myocardial performance index in the evaluation of right ventricular involvement in the acute and late phase of a first inferior myocardial infarction. Echocardiography, 28 (3) (2011), pp. 311–319

Gulati VK, Katz WE, Follansbee WP, Gorcsan J III. Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function. Am J Cardiol 1996;77:979-84.

Monika Garg, Akash Deep Aggarwal, SantPrakashKataria ; Coronary Atherosclerosis and Myocardial Infarction An Autopsy Study . J Indian Acad Forensic Med. Jan-Mar 2011, Vol. 33.

Yazdi SAT, Rezaei A, Azari JB, Hejazi A, Shakeri MT, Shahri MK. Prevalence of Atherosclerotic Plaques in Autopsy Cases with Noncardiac Death. Iranian J Pathol 2009;4(3):101-104.

Farb A, Tang AL, Burke AP, Sessums L, Liang Y, Virmani R. Sudden coronary death – Frequency of active coronary lesions, inactive coronary lesions and myocardial infarction. Circulation 1995;92:1701-9.


  • There are currently no refbacks.