Right Ventricular Infarction Complicated by Acute Right-WLeft Shunting

ight ventricular (RV) infarction occurs in 19% to 51% of patients with left ventricular inferior wall acute myocardial infarction4 The importance of RV infarction and its unique hemodynamic consequences were not well understood until the early 1970~.~ Among these consequences are hemodynamic disturbances that may be mistaken for left ventricular dysfunction, peri- cardial tamponade, or pulmonary embolism. Another serious consequence associated with RV infarction is sudden right-to-left shunting through a previously unsus- pected atria1 septal defect or patent foramen ovale.2-7 We describe herein 5 patients in whom RV infarction was associated with clinically important right-to-left shunting at the atria1 level, and resulted in significant sys- temic hypoxemia or paradoxic emboli. The study cohort consisted of 5 patients (3 men and 2 women, mean age 67 years (range 56 to 791) w'ho pre- sented uith either acute RV infarction associated with