Frequency of Isolated Right Ventricular Infarct, Their Clinical Presentation and In-Hospital Outcomes in Patients Presenting with Chest Pain in a Tertiary Care Hospital

Background: Isolated right ventricular infarction (IRVI) is a rare but clinically important subset of myocardial infarction that is often underdiagnosed due to atypical presentations and limitations of standard ECG interpretation. Prompt recognition is critical to avoid adverse outcomes. Objective: To determine the frequency, clinical presentation, and in-hospital outcomes of isolated right ventricular infarction among patients presenting with chest pain. Methods: This descriptive cross-sectional study was conducted at the Department of Cardiology, NICVD Karachi from September 2024 to March 2025. A total of 251 patients aged 18–65 years presenting with chest pain within 3 hours of symptom onset were enrolled using non-probability consecutive sampling. IRVI was diagnosed using right-sided ECG leads. Data on demographics, risk factors, clinical presentation, and in-hospital outcomes (heart failure, arrhythmia, stroke, and mortality). Results: The frequency of isolated right ventricular infarction was 2.78% (n = 07). Common symptoms among non-IRVI patients included excessive sweating (75%), palpitations (67.9%), vomiting (53.6%), and syncope (39.3%). IRVI patients had significantly higher rates of heart failure (p = 0.013), arrhythmia (p = 0.019), and mortality (p = 0.041) compared to non-IRVI patients. Significant associations were observed between IRVI and male gender (p = 0.045), diabetes mellitus (p = 0.027), and symptom duration less than 2 hours (p = 0.003). Conclusion: IRVI, though infrequent, carries a high risk of adverse outcomes. Early detection using right-sided ECG and attention to clinical red flags is essential for timely intervention and improved prognosis.