Diagnosis and Management of Right Ventricular Infarction

Patient Risk Factors and Clinical Presentation

Diabetes mellitus is a major risk factor for post-infarct mortality, with a 3-5 times greater risk, and qualifies patients as high-risk requiring urgent invasive strategy, according to the European Heart Journal 1, 2
Hemodynamic instability, such as hypotension, places patients in the category requiring coronary angiography within the first hour, as recommended by the European Heart Journal 1

A chest X-ray is not the immediate diagnostic tool of choice, as it does not provide time-sensitive information, and clear lung fields on auscultation already suggest absence of pulmonary edema, as noted in the European Heart Journal 3
An echocardiogram, although useful for assessing RV function, should follow ECG diagnosis and does not provide the immediate diagnostic information that right-sided ECG leads offer, according to the European Heart Journal 1
Coronary CT angiogram is contraindicated in acute MI with hemodynamic instability, and patients need immediate invasive coronary angiography, as stated in the European Heart Journal and the Journal of the American College of Cardiology 1, 4

The American College of Cardiology implies that immediate reperfusion therapy, such as primary PCI, should be initiated at the earliest signs of right ventricular dysfunction, although this fact is not directly cited, it can be inferred from the context and the European Heart Journal 1