When myocardial infarction is not only inferior: the importance of prehospital recognition of right ventricular infarction

  • Andrijana Ilić Zavod za urgentnu medicinu, Franse d'Eperea 5
  • Verica Vukićević Institute of Emergency Medicine, Belgrade https://orcid.org/0000-0002-1469-7617
  • Olja Mirković Institute of Urgent Medicine, Belgrade
  • Vanja Zmijarević Institute of Urgent Medicine, Belgrade
  • Ivana Stefanović Institute of Urgent Medicine, Belgrade
  • Bojana Aćimović Institute of Urgent Medicine, Belgrade
  • Radmila Ristić Mrkalj Institute of Urgent Medicine, Belgrade
DOI: https://doi.org/10.5937/halo31-63902
Keywords: Right ventricular infarction, hypotension, Erhardt's sign, RVI

Abstract


Introduction: Right ventricular myocardial infarction (RVI) occurs with complete occlusion of the right coronary artery proximal to the site of separation of the branches feeding the right ventricular wall. It rarely occurs independently, but it complicates about 50% of inferior infarctions. Clinically, it is recognized by the triad: hypotension, jugular venous distension and "clean" lungs. Vasodilators are contraindicated, while intravenous fluid replacement is the key of mennagement. Case report: A 50-year-old man complains of sudden shoulder pain, nausea and sweating. The ECG shows an infarction of inferior localization, with the greatest ST elevation in lead D3, combined with the clinical triad of RV infarction. ST elevation was also confirmed in V4R-V6R (Erhardt's sign). A rapid infusion of cristalloids was administrated, which led to an improvement in hemodynamics. Conclusion: Due to the worse prognosis of patients with right ventricular myocardial infarction and possible iatrogenic complications, early recognition and adequate treatment.

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Published
2026/02/23
Issue
Vol. 31 No. 3 (2025): Scientific Journal of Emergency Medicine Halo 194
Section
Case report
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