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Right heart strain

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Electrocardiogram of a person with pulmonary embolism, showingsinus tachycardiaof approximately 100 beats per minute, large S wave in Lead I, moderate Q wave in Lead III, inverted T wave in Lead III, and inverted T waves in leads V1 and V3.

Right heart strain(alsoright ventricular strainorRV strain) is amedical findingof right ventricular dysfunction[1]where theheart muscleof the right ventricle (RV) is deformed.[2]Right heart strain can be caused bypulmonary hypertension,[3]pulmonary embolism(or PE, which itself can cause pulmonary hypertension[4]), RVinfarction(a heart attack affecting the RV), chronic lung disease (such aspulmonary fibrosis),pulmonic stenosis,[5]bronchospasm,andpneumothorax.[6]

When using anechocardiograph(echo) to visualize the heart,[a]strain can appear with the RV being enlarged and more round than typical. When normal, the RV is about half the size of the left ventricle (LV). When strained, it can be as large as or larger than the LV.[5]An important potential finding with echo isMcConnell's sign,where only the RV apex wall contracts;[7]it is specific for right heart strain and typically indicates a large PE.[8]

On anelectrocardiogram(ECG), there are multiple ways RV strain can be demonstrated. A finding ofS1Q3T3[b]is an insensitive[10]sign of right heart strain.[11]It is non-specific (as it does not indicate a cause) and is present in a minority of PE cases.[12]It can also result from acute changes associated withbronchospasmandpneumothorax.[6]Other EKG signs include aright bundle branch block[13]as well as T wave inversions in the anterior leads, which are "thought to be the consequence of an ischemic phenomenon due to low cardiac output in the context of RV dilation and strain."[13]Aside from echo and ECG, RV strain is visible with aCT scanof the chest and viacardiac magnetic resonance.[14]

See also

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Notes

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  1. ^The apical-four-chamber (A4C) view is best to visualize right heart strain by echo.[5]
  2. ^Indicative of a prominent S wave in lead I, a Q wave in lead III, and an inverted T wave in lead III,[9]which is also known as theMcGinn–White sign[6]

References

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  1. ^Weerakkody, Yuranga."Right heart strain | Radiology Reference Article | Radiopaedia.org".radiopaedia.org.Retrieved2016-07-12.
  2. ^Rudski, Lawrence G.; Lai, Wyman W.; Afilalo, Jonathan; Hua, Lanqi; Handschumacher, Mark D.; Chandrasekaran, Krishnaswamy; Solomon, Scott D.; Louie, Eric K.; Schiller, Nelson B. (2010-07-01)."Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography"(PDF).Journal of the American Society of Echocardiography.23(7): 685–713 (see 704), quiz 786–788.doi:10.1016/j.echo.2010.05.010.PMID20620859.
  3. ^Koestenberger, Martin; Friedberg, Mark K.; Nestaas, Eirik; Michel-Behnke, Ina; Hansmann, Georg (2016-03-01)."Transthoracic echocardiography in the evaluation of pediatric pulmonary hypertension and ventricular dysfunction".Pulmonary Circulation.6(1): 15–29.doi:10.1086/685051.ISSN2045-8932.PMC4860554.PMID27162612.
  4. ^Shopp, Jacob D.; Stewart, Lauren K.; Emmett, Thomas W.; Kline, Jeffrey A. (2015-10-01)."Findings From 12-lead Electrocardiography That Predict Circulatory Shock From Pulmonary Embolism: Systematic Review and Meta-analysis".Academic Emergency Medicine.22(10): 1127–1137.doi:10.1111/acem.12769.ISSN1553-2712.PMC5306533.PMID26394330.
  5. ^abcMike Blaivas (3 April 2014).Emergency Medicine, An Issue of Ultrasound Clinics.Elsevier Health Sciences. p. 229.ISBN978-0-323-29021-0.
  6. ^abcHoughton, Andrew R.; Gray, David (2014-06-04).Making Sense of the ECG: Cases for Self Assessment, Second Edition.CRC Press. p. 62.ISBN9781444181852.
  7. ^Rogers, Robert L.; Scalea, Thomas; Geduld, Heike (2013-04-04).Vascular Emergencies: Expert Management for the Emergency Physician.Cambridge University Press. p. 208.ISBN9781107035027.
  8. ^Walsh, Brooks M.; Moore, Christopher L. (2015-09-01). "McConnell's Sign Is Not Specific for Pulmonary Embolism: Case Report and Review of the Literature".The Journal of Emergency Medicine.49(3): 301–304.doi:10.1016/j.jemermed.2014.12.089.PMID25986329.
  9. ^Kusumoto, Fred M. (2009-04-21).ECG Interpretation: From Pathophysiology to Clinical Application.Springer Science & Business Media. p. 259.ISBN9780387888804.
  10. ^Warrell, Emeritus Professor of Tropical Medicine David; Cox, Timothy; Dwight, Jeremy; Firth, Consultant Physician and Nephrologist John (2016-06-16).Oxford Textbook of Medicine: Cardiovascular Disorders.Oxford University Press. p. 527.ISBN9780198717027.
  11. ^Garcia, Tomas B.; Holtz, Neil (2011-11-15).12-Lead ECG.Jones & Bartlett Publishers. p. 347.ISBN9781449677893.
  12. ^Garcia, Tomas B.; Holtz, Neil (2011-11-15).12-Lead ECG.Jones & Bartlett Publishers. p. 290.ISBN9781449677893.
  13. ^abDigby, Geneviève C.; Kukla, Piotr; Zhan, Zhong-Qun; Pastore, Carlos A.; Piotrowicz, Ryszard; Schapachnik, Edgardo; Zareba, Wojciech; Bayés de Luna, Antonio; Pruszczyk, Piotr (2015-05-01)."The value of electrocardiographic abnormalities in the prognosis of pulmonary embolism: a consensus paper".Annals of Noninvasive Electrocardiology.20(3): 207–223.doi:10.1111/anec.12278.PMC6931801.PMID25994548.
  14. ^Tadic, Marijana (2015-12-01)."Multimodality Evaluation of the Right Ventricle: An Updated Review".Clinical Cardiology.38(12): 770–776.doi:10.1002/clc.22443.ISSN1932-8737.PMC6490828.PMID26289321.
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