Question

M.T. is a 72-year-old woman, who is transported by ambulance to the hospital, with dizziness, fainting, weakness, fatigue, nausea, sweating, shortness of breath, and indigestion (heartburn) pain. These symptoms began about 2 hours ago and have become progressively worse since arriving at the hospital. Blood pressure is 200/100; pulse is 102 and regular. Lung sounds are clear. No murmur is noted on cardiac auscultation. Her ECG and cardiac enzyme levels are indicative of myocardial infarction. Her past history is significant for smoking for 20 years. She did quit about 5 years ago. She says she has “always” had a high cholesterol level and she was told about 10 years ago that she was a “borderline diabetic.” Her mother had a “heart attack” at age 62. She is currently on a cholesterol-reducing drug and an antihypertensive drug. She does take these medications daily.

How could you determine if the infarction is in a left versus right coronary artery?

Answer 1

patient with RV Infraction present with symptoms commonly seen in left side infraction,including chestpain with or without radiation ,dyspnea,nausea and dizziness. These patients may exhibit rhythm abnormalities ranging from bradycardia to complete heart block. Hypotension may also be more common in this population.other signs of Right heart failure such as acute peripheral edema and jugular venous distension may also be present. Jugular vein distension, clear lung fields,and hypotension these are the classic feature of right coronary artery infraction .A pansystolic murmur best heard at the lower sternal border may indicate tricuspid regurgitation ,but due to the lower filling pressure of the right heart ,this is not always present. This characteristics can be used for determining the left versus right coronary artery infraction.