Right Ventricular Infarction Following Inferior STEMI: A Case Report and Comprehensive Review of Management Challenges

   Siyamak Jalal Hosseini¹, Mohammadreza Shoghli^2*, Hermon Eyob Fesseha³, Yosan Eyob⁴

¹Assistant Professor at Tehran University of Medical Sciences, Tehran, Iran, [email protected]; ²Ph.D. Helsinki, Department of Population Study, University of Helsinki, Helsinki, Finland, [email protected]; ³Hermon Eyob Fesseha1, Cardiology resident, Peijas Hospital District of Helsinki and Uusimaa (HUS), University of Eastern Finland; [email protected]; ⁴MD, general practitioner in private clinic Pihlajalinna, Finland, [email protected]

 Corresponding Author: ^2*Mohammadreza Shoghli, Ph.D. Helsinki, Department of Population Study, University of Helsinki, Helsinki, Finland, [email protected]

1. Introduction

Right ventricular infarction (RVI) is a life-threatening complication of inferior ST-elevation myocardial infarction (STEMI), occurring in approximately 30–50% of such cases—typically when the proximal right coronary artery (RCA) is occluded [1,2]. While left ventricular (LV) infarction receives more clinical focus, RVI significantly worsens patient outcomes and is often underdiagnosed due to nonspecific signs [3,4]. The right ventricle (RV) is anatomically distinct from the LV, with a thinner free wall, lower systolic pressure, and greater dependence on preload. These characteristics make the RV highly susceptible to ischemic damage and volume depletion. RV dysfunction can compromise left-sided output due to interventricular dependence, thereby leading to systemic hypotension and cardiogenic shock [5,6]. Although timely revascularization is the cornerstone of STEMI therapy, standard management strategies may be inadequate in dominant RVI. In such cases, mechanical support such as right ventricular assist devices (RVADs) or extracorporeal membrane oxygenation (ECMO) can be lifesaving. Unfortunately, these are not universally accessible, particularly in resource-limited settings [7]. We present a case of inferior STEMI with RVI, highlighting the limitations of current management and the impact of unavailable mechanical RV support.