Why no Nitrates in Right Ventricle Myocardial Infarction (MI)?

Up to 40% of inferior wall Myocardial infarctions have associated right ventricular involvement. Venodilation and medications that decrease RV filling (i.e nitrates, diuretics) should be avoided.

WHY?

The right ventricle contains less myocardial tissue compared to the left ventricle. It is more dependent on adequate preload (Frank-Starling curve) to assure adequate cardiac function (CO). If there is damage to the right ventricle, preload reduction from nitrates/ diuresis could result in significant hypotension.

REFERENCES

  1. Albulushi A., et al. Acute right ventricular myocardial infarction. Expert Rev Cardiovasc Ther. 2018 Jul;16(7):455-464.
  2. Bouhuijzen LJ, Stoel MG. Inferior acute myocardial infarction with anterior ST-segment elevations. Neth Heart J. 2018 Oct;26(10):515-516.

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