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European Heart Journal 1988 9(5):534-540;
Copyright © 1988 by the European Society of Cardiology.
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© 1988 The European Society of Cardiology

Acute right ventricular infarction secondary to massive pulmonary embolism

I. COMA-CANELLA*, C. GAMALLO{dagger}, P. MARTINEZ ONSURBE{dagger} and J. LOPEZ-SENDON*

*Unidad Coronaria Hospital La Paz, Madrid, Spain
{dagger}Servicio de Anatomia Patologica Hospital La Paz, Madrid, Spain

Received 7 July 1987; revised 2 November 1987; .

Address for reprints. I. Coma-Canella, Unidad Coronaria, Hospital La Paz, Paseo de la Castellana 261, 28046-Madrid, Spain.

Abstract

Isolated right ventricular infarction has been found in cases of right ventricular hypertrophy, but there are no reports on right ventricular infarction secondary to massive pulmonary embolism. Six autopsied patients with massive pulmonary embolism and pure right ventricular infarction, suspected to be secondary to the embolism, were selected from a population of 216 autopsies. Pulmonary embolism was the suspected diagnosis in five cases due to typical clinical, electrocardiographic and haemodynamic data. Right ventricular infarction was a post-mortem finding, not previously diagnosed. In every case the thickness of the right ventricular myocardium was normal. The necrosis of the right ventricle was transmural in four cases and subendcardial in two and the entire right ventricular wall (anterolateral as well as posterior) was involved. No mural thrombi were present and in no case did the necrosis involve the left ventricle. In one case the coronary arteries were normal, in the other five significant lesions of the right or the left coronary arteries were observed. These lesions may have been, in part, responsible for the necrosis of the right ventricle when the massive pulmonary embolism was added. We conclude that right ventricular infarction may be secondary to pulmonary hypertension in the setting of massive pulmonary embolism, even in the absence of right ventricular hypertrophy and with normal or stenotic coronary arteries.

Key Words: Pulmonary embolism • right ventricular infarction • acute myocardial infarction


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