Advertisement

Pulmonary embolism in the differential diagnosis of right ventricular myocardial infarction

      When right ventricular failure occurs as a result of right ventricular myocardial infarction (RVMI) [
      • Davis W.T.
      • Montrief T.
      • Koyfman A.
      • Long B.
      Dysrhythmias and heart failure complicating acute myocardial infarction: an emergency medicine review.
      ], its manifestations can be closely simulated by right ventricular failure attributable to pulmonary embolism (PE) [
      • Namana V.
      • Gupta S.S.
      • Abbasi A.A.
      • Raheja H.
      • Shani J.
      • Hollander G.
      Right ventricular infarction.
      ,
      • Al-Mane N.
      • Al-Mane F.
      • Abdalla Z.
      • McDonnell J.
      Acute surgical abdomen: an unusual presentation of pulmonary embolus.
      ]. In the latter example of PE-related right ventricular failure a 35 year old previously healthy woman (a non-smoker) presented with severe abdominal pain and abdominal distension, but denied dyspnea or chest pain. Exploratory laparotomy revealed that she had a congested and very enlarged liver, and ascites as well. Further investigations included echocardiography, which disclosed a right ventricular systolic pressure of 77 mm Hg, and tricuspid regurgitation. These derangements were attributable to right ventricular failure resulting from massive PE [
      • Al-Mane N.
      • Al-Mane F.
      • Abdalla Z.
      • McDonnell J.
      Acute surgical abdomen: an unusual presentation of pulmonary embolus.
      ]. According to Namana et al., RVMI most closely simulates PE when it presents with “chest pain, diaphoresis, nausea and vomiting with [the] hemodynamic triad:hypotension, jugular venous distension and clear lung fields” [
      • Namana V.
      • Gupta S.S.
      • Abbasi A.A.
      • Raheja H.
      • Shani J.
      • Hollander G.
      Right ventricular infarction.
      ]. Dysrhythmias which occur in RVMI, such as atrial fibrillation and complete heart block [
      • Goldstein J.A.
      Pathophysiology and management of right heart ischemia.
      ], also occur in PE [
      • Bikdeli B.
      • Ziki M.D.
      • Lip G.Y.H.
      Pulmonary embolism and atrial fibrillation: two sides of the same coin? A systematic review.
      ,
      • Elias J.
      • Kuniyoshi R.
      • Moulin B.
      • Cuhna F.
      • Castro E.
      • Nunes A.
      • et al.
      Syncope and complete atrioventricular block related to pulmonary thromboembolism.
      ].
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Davis W.T.
        • Montrief T.
        • Koyfman A.
        • Long B.
        Dysrhythmias and heart failure complicating acute myocardial infarction: an emergency medicine review.
        Am J Emerg Med. 2019; ([Article in Press])
        • Namana V.
        • Gupta S.S.
        • Abbasi A.A.
        • Raheja H.
        • Shani J.
        • Hollander G.
        Right ventricular infarction.
        Cardiovasc Revasc Med. 2018; 19: 41-50
        • Al-Mane N.
        • Al-Mane F.
        • Abdalla Z.
        • McDonnell J.
        Acute surgical abdomen: an unusual presentation of pulmonary embolus.
        J Investig Med High Impact Case Rep. 2014; https://doi.org/10.1177/2324709614542339
        • Goldstein J.A.
        Pathophysiology and management of right heart ischemia.
        JACC. 2002; 40: 841-853
        • Bikdeli B.
        • Ziki M.D.
        • Lip G.Y.H.
        Pulmonary embolism and atrial fibrillation: two sides of the same coin? A systematic review.
        Semin Thromb Hemost. 2017; 43: 849-863
        • Elias J.
        • Kuniyoshi R.
        • Moulin B.
        • Cuhna F.
        • Castro E.
        • Nunes A.
        • et al.
        Syncope and complete atrioventricular block related to pulmonary thromboembolism.
        Arq Bras Cardiol. 2004; 83: 438-441
        • Makavos G.
        • Cholevas N.V.
        • Rallidis L.S.
        A reversible cause of hypoxaemia in a patient with acute right ventricular infarction.
        Hellenic J Cardiol. 2019; ([Article in press])
        • Albaghdadi A.
        • Teleb M.
        • Porres-Agullar M.
        • Porres-Munoz M.
        • Marmol-Velez A.
        The dilemna of refractory hypoxemia after inferior wall myocardial infarction.
        Proc Baylor Univ Med Cent. 2018; 31: 67-69