Characteristics of right ventricular infarction, causes of the disease and methods of therapy

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2017.06.06
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Heart Attack

The pathological condition called right ventricular infarction is rarely diagnosed and in most cases occurs against the background of a common left ventricular lesion. Its cause is usually impaired blood circulation in the proximal zones of the coronary artery on the right side.

Since the right ventricular heart muscle needs less oxygen, the necrosis of this area develops very long and very rarely. In general, myocardial infarction of this type, according to statistical data, occupies 15% of the total number of cases of this dangerous diagnosis. A patient with this diagnosis always needs quick medical help, since such a myocardial infarction can lead to many complications and cause the patient to die.

Content

  • Description and causes of development
  • Manifestations of the disease
  • Diagnosis of the state
  • Principles of treatment

Description and causes of development

The work of the right ventricle is to transfer blood from the veins to the lungs and then to the left ventricular zone. This part of the heart is a muscular chamber with thick walls. When this department starts to malfunction, first of all it affects the pulmonary system and eventually leads to LV failure. As the blood flow to the ventricle on the left side decreases, the pressure also decreases. The infarction lesion area includes the back wall of the left ventricle if it is a posterior diaphragmatic form, and then spreads to the posterior area of ​​the prostate.

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Important! In this disease, the focus of ischemia and necrotic lesions first affect the back wall of the LV and pass to the wall of the right ventricle, which eventually causes the defeat of two chambers Simultaneously.

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The front or side walls are included in the process in rare cases. Against the backdrop of the development of the disease, the patient has acute ventricular failure on the right side, outwardly this manifests itself in the form of edema and increased liver volume. Transition of the disease from the left ventricle to the RV signals a worsening of the patient's condition.In this case, supportive therapy and other procedures are designed to control the work of the heart and other organs. The list of reasons provoking the development of myocardial infarction of the prostate can include:

  • atherosclerotic changes in the right coronary artery;
  • ischemic lesions of the heart on the right side;
  • myocardial necrosis of the right ventricle.
Structure of the heart

Manifestations of the disease

As the right ventricular myocardial infarction progresses, the vessel may become clogged. In its place is formed ischemic site, which is subjected to necrosis in the absence of complex and timely therapy. If it is an isolated myocardial infarction, this process includes three nodes: sinoatrial, atriovesicular and atrial. Damage to these nodes manifests itself in the form of arrhythmia in patients who have recently undergone the disease, often there are additional complications, for example, AV blockade, sinus type bradycardia, or fibrillation of the atria.

In rare cases, the patient may develop a myocardial infarction of the atria, provoked by IMPD. When the necrotic lesion captures a large area, including the pancreas zone, the patient begins to show symptoms of insufficient right ventricle in the form of low pressure and edema. Often the patient complains of the symptoms of hypotension, which is caused by an inadequate reduction of the prostate gland due to necrotic lesions. In this case, he is no longer able to provide blood in the arteries of the lungs. Pressure in the right atrium during this period significantly exceeds the permissible standards.

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Important! The clearest sign of the UTI is always a noticeable increase in the size of the veins of the neck during the inspiration process. The reason for this is the inability of the right ventricle to increase the stroke volume as the blood flow increases.

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This causes the accumulation of blood in the area of ​​a large circle of blood circulation. Often, the level of pressure in the atrium is equal to the pressure in the artery. During the examination, the doctor usually pays attention to the main signs of myocardial infarction, for example, on protrusion of veins in the neck area. Such a sign is called Kussmaul syndrome, (the name is given in honor of the famous German therapist), its cause is an overabundance of blood in the arteries and veins in a large circle. Diagnosis of PI heart attack includes the following symptoms:

  • shortness of breath, which is accompanied by a constant shortage of air due to a lack of oxygen to enrich the blood;
  • pains of an acute nature in the retrosternal region, which last from five to fifteen minutes;
  • dizziness or fainting due to low blood pressure and impaired brain supply with sufficient blood;
  • confused consciousness caused by lack of oxygen, usually this symptom is accompanied by constant craving for sleep, problems with thinking, apathy, or aggressive excitement;
  • decrease in urine output due to impaired blood supply to the kidneys provoked by hypotension;
  • blueing of the hands and feet, as well as some areas of the skin due to stagnation of blood in the venous lobe, as well as insufficient oxygen;
  • swollen veins in the neck area as a result of weakening the operation of the prostate and its pumping function.
Necrotic lesion in case of infarction

Diagnostic state

As the specialist fixes signs and symptoms of UTI, he needs to conduct the most detailed examination to confirm the presence of a heart attack in the patient. Usually this diagnosis is made when three characteristic signs are found: hypotension of the arterial type, increased pressure in the right atrium and in the jugular veins and a lack of wheezing in the process of pulmonary auscultation. First of all, the cardiologist appoints the patient to pass an electrocardiogram with an abduction, by means of which it is possible to clearly define the lesion and the stage of the disease.

To confirm the diagnosis, you will need to check additional lead in the chest area. Such leads are removed when the doctor suspects having a right ventricular infarction posterior diaphragmatic or posterior basal type, and also in the absence of possibility to confirm a heart attack at standard ECG removal. Removal of V3R-V6R should be recorded already in the first hours of the illness in order to find out the exact diagnosis. In the process of electrocardiogram with entrainment on the chest on the right impose electrodes, which are under the numbers. To remove the right lead, you need electrodes numbered from 3 to 6.

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Important! Under reduced pressure during the infarction of the prostate, the patient is prescribed infusion therapy. In this case, it is not recommended to take vasopressors, which are capable of increasing the load on the prostate.

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Since the coronary artery located on the right side supplies blood to the posterior parts of both the right and left ventricles, myocardial infarction in most cases affects both departments at once. Sometimes the branches of the coronary artery, located on the right, affect the upper and lateral parts of the left ventricle. The infarction is characterized by multiple lesion of the coronary arteries, which is found in 75% of patients in the process of diagnosing myocardial infarction of the right ventricle in ECG time. The list of changes found on the ECG includes:

  • Elevation of the ST segment in the indicated lead;
  • pathology of the Q wave;
  • negative stage of the T wave;
  • necrotic lesion of anterior or lateral wall of the ventricle;
  • blockade of the bundle of His (the term characteristic of this disease);
  • blockade of the atrioventricular type.

This pathology usually causes the development of blood circulation along the collateral type. In the clinic, doctors usually take additional indications when ECG symptoms are typical of myocardial infarction of the prostate. The list of such indications should always include taking readings in the field of right leads with V3R and V6R numbers and corresponding names. If the pancreatic infarction is confirmed when checking the lead, it will help to noticeably adjust the treatment process and prevent a number of undesirable consequences.

Example of ECG with right ventricular infarction

Principles of treatment

The method of treatment of patients with diagnosed myocardial infarction of the prostate depends on additional pathologies, the condition of the patient and the presence of other diseases - in each case, therapy is prescribed individually. If arterial hypotension was detected during the diagnosis, in this case, the introduction of special solutions intravenously: the list of common drugs include sodium chloride, dextran or rheopolyglucin. Names and names of other drugs should be checked with your doctor. These measures are aimed at increasing the circular function of blood. Sometimes they do not bring results, and then the doctor prescribes the administration of dopamine or dobutamine.

The extreme measure is balloon-type angioplasty or the appointment of thrombolytic therapy, as well as ECS. Usually, to improve the patient's condition, it is enough to normalize the BCC and provide a sufficient level of pressure when filling the right ventricle. Additionally, during treatment, local hemodynamic effects will need to be eliminated. This is possible by observing all the principles of therapy, timely administration of drugs and providing the patient with the necessary care. The list of integrated measures for treatment of UTI usually includes:

  • Reperfusion procedures in the area of ​​the ischemic focus;
  • a sharp decrease in physical activity;
  • constant control of heart rate;
  • maintenance of cardiac output by the use of nootropic drugs.
Artery before and after angioplasty

special instructions

In the process of treatment of myocardial infarction of the right ventricle, doctors try not to prescribe diuretic and nitrate preparations, since The area of ​​the affected area, including during ischemic injury, has an excessive sensitivity to additional loads. These drugs, as well as means for narrowing the vessels, are usually excluded from therapy, so as not to overload the RV area.Analgesic drugs, whose names must be specified by a specialist, are also able to narrow the vessels. If their reception is necessary for the patient, the specialists try to replace them with similar means.

The introduction of special solutions with a right ventricular infarction allows for a short time to normalize the patient's condition and significantly alleviate a number of unpleasant symptoms. The purpose of introducing the solution is to restore the volume of blood in the ventricle and to eliminate the reduced pressure that accompanies this type of infarction in the vast majority of cases. During the introduction, specialists monitor hemodynamic parameters in order to take timely measures in case of need. Usually, when the condition is normal, the venous pressure index of the patient reaches a value of 15 mm Hg, which is considered an acceptable value.

When the application of the solution is ineffective, the patient is given the intake of special preparations to increase the frequency of muscle contractions. The list of the most common drugs of this type include drugs dopamine and dobutamine. In the presence of arrhythmia, a special correction with atropine is recommended, in the case of its inability to receive due to various contraindications, temporary pacing is used.

Installed pacemaker

Such measures can normalize the course of the disease and avoid undesirable consequences. In each case, therapy is prescribed individually, taking into account the characteristics of the patient. Often, doctors prefer to use inhibitors of AGTF, which can eliminate the negative symptoms of heart failure. Strict control of specialists contributes to the optimal course of the treatment process, with timely measures taken achieve a lasting improvement and noticeably normalize the work of the right ventricle, and also improve the overall myocardial infarction.

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