A revision of the pathophysiology clinical classification and treatment of the right ventricular infarction (RVI) is presented. For many years it was believed that right ventricular (RV) contraction was neither important nor crucial to the maintenance of systemic circulation. Although non-invasive studies have reported RV dilation and RV wall motion abnormalities in 50% of patients with inferior--posterior--left ventricular myocardial infarction, RV involvement leads to significant hemodynamic compromise in less than half of such cases. When RVI patients are identified, they should be classified in those without RV failure (Class A), those with RV failure (Class B) and those with shock (Class C). Concerning the role of reperfusion therapies, both therapies (TT or PCI) seem beneficial, because a trend in the reduction of mortality has been observed. A decrease in RV failure was noted in class B patients, and PCI appears to be the procedure of choice in class C patients, since it significantly reduced mortality.