Why no JVD in Right MI Cardiogenic Shock?

[Bleepbloopblop]

UWorld states in RVMI, hypotension and low or normal jugular venous pressure strongly suggest cardiogenic shock due to inadequate RV preload.

I understand why LVMI cardiogenic shock leads to JVD due to backup of blood, but why wouldn't this occur in RVMI? Thanks.

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[Rahas]

I don't remember the question but I'm fairly certain you've misinterpreted what you read. RVMI leading to cardiogenic shock will cause raised JVP.

Low intravascular volume (as made obvious by observing low JVP) increases the risk of a RVMI patient progressing to cardiogenic shock.

RV output depends on:
1.Contractility: this is decreased in RVMI (loss of cardiomyocytes)
2.Preload (via the FS mechanism)

Decreased preload superimposed on decreased contractility will amplify the reduction in RV output.

Hence treat RVMI by increasing preload with fluids. Don't overdo it though, if JVP is normal or increased, fluids can be skipped. (The exact indications are something I'm unaware of).

 

[Rahas]

What you've read might be implying cardiogenic shock was precipitated in a RVMI patient because preload wasn't normalized.

 

[hardpecs]

The only case that comes to mind is decompensated chronic heart failure. The excessive hypertrophy coupled with sympathetic downregulation causes subendocardial ischemia. In this setting, you could see RV MI coupled with low/normal JVP, as chronic heart failure has a setting of low/normal JVP.

 

[Instatewaiter]

UWorld states in RVMI, hypotension and low or normal jugular venous pressure strongly suggest cardiogenic shock due to inadequate RV preload.

I understand why LVMI cardiogenic shock leads to JVD due to backup of blood, but why wouldn't this occur in RVMI? Thanks.

In an RV infarction, you need a higher filling pressure to maintain cardiac output. Therefore, one of the hallmarks of an RV infarction is an elevated jugular venous pressure .

I think you are missing part of the explanation .