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Physical Examination for Exclusion of Hemodynamically Important Right Ventricular Infarction

LOUIS J. DELL'ITALIA, M.D.; MARK R. STARLING, M.D.; and ROBERT A. O'ROURKE, M.D.
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▸Requests for reprints should be addressed to Louis J. Dell'Italia, M.D.; The University of Texas Health Science Center, Department of Medicine, Division of Cardiology; 7703 Floyd Curl Drive; San Antonio, TX 78284.


San Antonio, Texas


©1983 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1983;99(5):608-611. doi:10.7326/0003-4819-99-5-608
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Fifty-three consecutive patients with inferior myocardial infarction were evaluated prospectively, by physical examination and right heart catheterization within 36 hours of the onset of symptoms, to determine whether physical findings can separate such patients into those with and without associated right ventricular infarction. Hemodynamic findings consistent with right ventricular infarction were defined as right atrial pressure of 10 mm Hg or greater and a right atrial: pulmonary artery wedge pressure ratio of 0. 80 or greater. Eight patients (Group 1) had hemodynamic evidence of right ventricular infarction, whereas 45 patients (Group 2) did not meet these criteria. Group 1, compared with Group 2, had a lower cardiac index (1.8 ± 0.3 versus 2.6 ± 0.6 L/min · m2, p < 0.001), and a lower right ventricular stroke work index (4.1 ± 3.6 versus 7.3 ± 3.2g · m/m2, p < 0.05). An elevated jugular venous pressure of 8 cm H2O or more was seen in 7 of 8 Group 1 and 14 of 45 Group 2 patients (p < 0.01). In addition, a Kussmaul's sign, substantiated by hemodynamic findings, was seen in all 8 Group 1 and in no Group 2 patients (p < 0.001). The absence of both an elevated jugular venous pressure and a Kussmaul's sign in patients with inferior myocardial infarction makes the presence of a hemodynamically significant right ventricular infarction highly unlikely.

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