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Article
February 5, 1988

Right Ventricular Myocardial Infarction

Author Affiliations

From the Departments of Medicine (Cardiology) and Pathology Tufts New England Medical Center, Boston.

From the Departments of Medicine (Cardiology) and Pathology Tufts New England Medical Center, Boston.

JAMA. 1988;259(5):713-718. doi:10.1001/jama.1988.03720050049022
Abstract

THE CLASSIC morphological features of right ventricular myocardial infarction (RVMI) are illustrated in Fig 1. Necropsy observations1 have established that RVMI is principally a complication of myocardial infarction involving the posterior ("inferior") free wall of the left ventricle. Moreover, transmural infarction of the posterior ventricular septum is an additional prerequisite for RVMI. The extent of right ventricular free-wall involvement forms the basis for anatomic classification of RVMI (Fig 2).1,2 Most cases of RVMI examined at necropsy are limited to the posterior right ventricular free wall. Analysis of RVMI by anatomic grades has disclosed that extensive RVMI is not required to express disturbed hemodynamics.1,2 When profound hemodynamic alterations are observed in association with an anatomically small RVMI, eg, grade I, the discrepancy may be due to temporary "stunning" of the adjacent, noninfarcted portion of the right ventricular free wall (Fig 3). Thus, clinically "dominant" RVMI3 does not

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