From the Research
Post infarction septal bounce signifies right ventricular dysfunction following a myocardial infarction, indicating a poorer prognosis and requiring more aggressive management of right ventricular failure. This abnormal motion of the interventricular septum appears as a characteristic bouncing or rocking movement during cardiac imaging, particularly on echocardiography. It occurs when the right ventricle is unable to efficiently eject blood, causing pressure and volume overload that alters normal septal mechanics. The septal bounce is typically seen during early diastole and represents abnormal interventricular dependence, where the dysfunctional right ventricle affects left ventricular filling.
Key Points
- The presence of a septal bounce after myocardial infarction is most commonly associated with right ventricular infarction, usually occurring when there is occlusion of the right coronary artery that supplies the right ventricle 1.
- Recognition of this sign is important as right ventricular involvement in myocardial infarction can be easily missed but significantly impacts treatment decisions and patient outcomes.
- Management of post-myocardial infarction ventricular septal defects (VSD) is critical, with surgical closure being the standard of care, although transcatheter VSD closure (TCC) devices have become an alternative or adjunct to surgical closure 2, 3.
- The choice between surgical closure and TCC should be based on factors including complexity of the defect, availability of closure devices, expertise of the operator, and clinical condition of the patient 3.
Management Considerations
- Careful fluid management, inotropic support if needed, and optimization of preload and afterload are crucial in managing right ventricular failure associated with post infarction septal bounce.
- The use of beta-blockers, such as metoprolol or carvedilol, may be beneficial in certain patients, although the choice of beta-blocker and dosage should be individualized based on patient characteristics and clinical presentation 4.
- Mechanical circulatory support, such as extracorporeal membrane oxygenation, may be considered in patients with severe right ventricular failure or cardiogenic shock 2.