Value of two-dimensional echocardiography, electrocardiography, and clinical signs in detecting right ventricular infarction.

Noninvasive tests for the diagnosis of right ventricular (RV) infarction--two-dimensional echocardiography (2DE), ST elevation in V4R, and clinical parameters--were compared with equilibrium gated blood pool study (GBPS) in 50 patients after acute inferior myocardial infarction. Twenty-two of 50 patients had RV wall motion abnormalities on GBPS and 20 of 50 on 2DE. Sensitivity and specificity of 2DE was 82% and 93%, ST elevation in V4R was 50% and 71%, elevation of venous pressure was 77% and 85%, and a positive Kussmaul's sign was found in 59% and 89% for the detection of RV infarction compared to GBPS. Patients with RV infarction had higher peak creatine kinase levels and lower left ventricular ejection fractions than patients without RV infarction. Three patients died and all had significant left ventricular damage. At 20 weeks' follow-up, two thirds of the patients had no residual RV wall motion abnormalities, and all but two patients showed some recovery.