Overview
Right ventricular myocardial infarction (RVMI) is a specific type of myocardial infarction affecting the right ventricle. It often occurs in conjunction with inferior wall myocardial infarction.Diagnosis
RVMI is typically diagnosed in the setting of inferior ST-elevation myocardial infarction (STEMI) 1.Management
Current guidelines from the American Heart Association (AHA) and European Society of Cardiology (ESC) recommend against the use of nitrates in patients with RVMI due to concerns about reducing preload and cardiac output, potentially leading to hypotension 1.
A systematic review and meta-analysis of five studies (n=1113) found no statistically significant difference in the relative risk of adverse events with sublingual nitroglycerin 400 μg in patients with concomitant inferior and RVMI compared to inferior MI alone (RR 1.31, 95% CI 0.81-2.12) 1.
The absolute effect was an increase of 3 additional adverse events per 100 treatments 1.
The review concluded that the contraindications to nitrates in RVMI are not strongly supported by current evidence, noting that adverse events were transient and manageable 1.
Limitations of the review include all studies having concomitant inferior and RVMI, not evaluating beneficial effects, and very low certainty of evidence 1.Key Recommendations
Current AHA and ESC guidelines recommend against the administration of nitrates in patients with RVMI due to the risk of hypotension 1. (Evidence: Expert opinion)
A meta-analysis suggests that the contraindication to nitrates in RVMI is not strongly supported by evidence, with no statistically significant increase in adverse events observed in patients with concomitant inferior and RVMI treated with sublingual nitroglycerin 1. (Evidence: Moderate)References
1 Wilkinson-Stokes M, Betson J, Sawyer S. Adverse events from nitrate administration during right ventricular myocardial infarction: a systematic review and meta-analysis. Emergency medicine journal : EMJ 2023. link