الفهرس 
Acute ST Elevation MyocardialOnly 14 pages are availabe for public view
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Abstract
Acute myocardial infarction is characterized by loss of contractile tissue and changes of the ventricular geometry. The right ventricle plays an important role in the morbidity and mortality of patients presenting with signs and symptoms of cardiopulmonary disease (Haddad et al., 2008).
To differentiate the normal right ventricular structure and function from abnormal and to assess the right ventricle size, volume and contractility a complete set of standardized views must be obtained. Echocardiographic assessment of the right ventricle has been largely qualitative, primarily because of the difficulty with assessment of the RV volumes because of its unusual shape. A gradual shift to more quantitative approaches for assessment of RV size and function will help standardize assessment of the right ventricle across laboratories and allow clinicians to better incorporate assessment of the right heart functions (Rudski et al., 2010).
The aim of this work was to study the structural and functional changes of the right ventricle by different echocardiographic modalities after the first attack of acute ST elevation myocardial infarction of different locations (Anterior and Inferior). The patients were selected from the coronary care unit of Ain-Shams university hospital during the period from February 2011 to July 2011.
The current study included 30 Patients with first attack of acute ST elevation myocardial infarction admitted to CCU unit and diagnosed by at least two of the following: typical ischemic chest pain > 20 minutes in duration, electrocardiographic evidence of ST elevation ≥ 1 mm in two or more consecutive leads and elevation of serum cardiac enzymes especially CK-MB.
Patients who had left bundle branch block, atrial fibrillation, valvular heart disease or other left sided heart disease, previous history of ischemic heart disease, previous coronary artery by pass graft surgery (CABG), percutaneous coronary artery intervention (PCI) and with pre-existing pulmonary disease were excluded from the study.
In this study, the patients were divided into two main groups regarding the site of myocardial infarction, group A included 18 patients with first attack of acute anterior ST elevation myocardial infarction and group B included 12 patients with first attack of acute inferior ST elevation myocardial infarction. There was no statistically significant difference between the two groups regarding the clinical and demographic data.
Regarding transthoracic echocardiographic measurements of the right ventricle dimensions showed that: there was significant increase in the right ventricular dimensions at the basal level and longitudinal level in the patients with first attack of acute inferior ST elevation myocardial infarction.
There was statistically significant difference between the two studied groups regarding the tricuspid annular plane systolic excursion (TAPSE) with lower TAPSE in patients with first attack of acute inferior ST elevation myocardial infarction reflecting the more affection of the right ventricular systolic function in this group of patients.
There was tendency towards lower RV FAC and RVS’ in the inferior group of patients compared to the anterior group, however the difference was statistically non significant.
Most of the patients in the present study were reported having variable degrees of right ventricular diastolic dysfunction during the early period of myocardial infarction. All the anterior infarction patients had right ventricle diastolic dysfunctions and 66.7 % of the inferior infarction patients with statistically significant differences in the anterior patients and this was mostly due to the ventricular interdependence and it was mandatory to confirm this RV diastolic dysfunction by tissue Doppler which was not applied in present study.
There was statistically significant difference between the two studied groups regarding the left ventricle EF and SWMSI where the patients with first attack of acute anterior ST elevation myocardial infarction had significant lower LV EF and higher SWMSI than the patients with first attack of acute inferior ST elevation MI.
However, the present study revealed that there was diastolic filling impairment of the left ventricle in varying degrees with the patients of first attack of acute ST elevation myocardial infarction but there was no statistically significant difference between the two studied groups.
The routine echocardiographic assessment of the patients with acute STEMI used to assess the left ventricular functions as it affect the prognosis (mortality and morbidity), but assessment of the right ventricular functions recommended as a routine also because it plays a role in the outcome of the patients with acute STEMI.