Russian Heart Failure Journal 2010year Hemodynamic characteristics of acute heart failure in patients with myocardial infarction of right and left ventricles


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2010/

Hemodynamic characteristics of acute heart failure in patients with myocardial infarction of right and left ventricles

Saiganov S. A., Grishkin Y. N.

Keywords: myocardial infarction of right ventricle, acute right ventricular failure, acute heart failure, central hemodynamic

DOI: 10.18087/ rhfj.2010.3.1330

Topicality. Myocardial infarction of both ventricles is often complicated by hemodynamic disorders with adverse prognosis. Understanding the process of acute HF (AHF) development will allow to optimize treatment approaches and find more rational way of hemodynamic disorders correction. Objective. To study mechanisms of hemodynamic disorders in patients with myocardial infarction of both ventricles during first day of disease and in dynamics. Materials and methods. We examined 76 patients with inferior MI. 41 patients with MI of both ventricles, complicated by acute right ventricular failure (ARVHF), were in group A. Group B (control) included 35 patients with inferior MI with no signs of AHF and RV infarction. Echocardiography was performed in all 76 patients during first day, and was repeated for group A on 4-th day. Invasive hemodynamic monitoring in group A was carried out during first four days of the disease. Results. In group A, in addition to extended right heart chambers, there was larger area of LV damage (39.9±0.97% vs 26.7±0.89% in group B, p<0.05). LV ejection fraction in group A was lower than in control group (37.5±0,88% and 52.6±1.09% respectively, p<0.05). In group A increase of transverse heart size (due to enlarged LV from 52.3±0.58 up to 55.1±0.58 mm) was revealed on the 4-th day from the beginning of MI. That was be evidence of pericardium stretching and improvement of LV blood filling. At baseline there was pulmonary hypotension and elevated central venous pressure (CVP) in group A On the 4-th day pulmonary artery pressure (PAP) increased from baseline (16.2±0.21) to 20.2±0.37 mm Hg with decrease of CVP (from 11.2±0.25 to 8.8±0.19 mm Hg). So the difference between PAP and CVP increased, that was the result of RV increased contractility. PAP positive dynamics led to improved perfusion of organs and tissues. Thus, the main reasons for AHF development in patients with MI with involvement of both ventricles are ARVHF (with decreased blood return to LV) and LV weakness (caused by extensive zone of LV damage and lack of infill). By 4-th day LV infill increases due to improved RV contractility and pericardium tension.
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Saiganov S. A., Grishkin Y. N. Hemodynamic characteristics of acute heart failure in patients with myocardial infarction of right and left ventricles. Russian Heart Failure Journal. 2010;11(3):148-152.

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