Right heart strain (also right ventricular strain or RV strain) is a medical finding of right ventricular dysfunction where the

heart muscle Cardiac muscle (also called heart muscle or myocardium) is one of three types of vertebrate muscle tissues, the others being skeletal muscle and smooth muscle. It is an involuntary, striated muscle that constitutes the main tissue of the wall of ...

of the right ventricle (RV) is deformed. Right heart strain can be caused by

pulmonary hypertension Pulmonary hypertension (PH or PHTN) is a condition of increased blood pressure in the pulmonary artery, arteries of the lungs. Symptoms include dypsnea, shortness of breath, Syncope (medicine), fainting, tiredness, chest pain, pedal edema, swell ...

pulmonary embolism Pulmonary embolism (PE) is a blockage of an pulmonary artery, artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include dyspnea, shortness of breath, chest pain ...

(or PE, which itself can cause pulmonary hypertension), RV

infarction Infarction is tissue death (necrosis) due to Ischemia, inadequate blood supply to the affected area. It may be caused by Thrombosis, artery blockages, rupture, mechanical compression, or vasoconstriction. The resulting lesion is referred to as a ...

(a heart attack affecting the RV), chronic lung disease (such as

pulmonary fibrosis Pulmonary fibrosis is a condition in which the lungs become scarred over time. Symptoms include shortness of breath, a dry cough, feeling tired, weight loss, and nail clubbing. Complications may include pulmonary hypertension, respiratory ...

pulmonic stenosis Pulmonic stenosis, is a dynamic or fixed obstruction of flow from the right ventricle of the heart to the pulmonary artery. It is usually first diagnosed in childhood. Signs and symptoms Some individuals with mild PS may not experience any sympt ...

bronchospasm Bronchospasm or a bronchial spasm is a sudden bronchoconstriction, constriction of the muscles in the walls of the bronchioles. It is caused by the release (degranulation) of substances from mast cells or basophils under the influence of anaphylat ...

, and

pneumothorax A pneumothorax is collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and dyspnea, shortness of breath. In a minority of cases, a one-way valve is ...

. When using an

echocardiograph Echocardiography, also known as cardiac ultrasound, is the use of ultrasound to examine the heart. It is a type of medical imaging, using standard ultrasound or Doppler ultrasound. The visual image formed using this technique is called an echoc ...

(echo) to visualize the heart, 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. An important potential finding with echo is McConnell's sign, where only the RV apex wall contracts; it is specific for right heart strain and typically indicates a large PE. On an electrocardiogram (ECG), there are multiple ways RV strain can be demonstrated. A finding of S1Q3T3 is an insensitive sign of right heart strain. It is non-specific (as it does not indicate a cause) and is present in a minority of PE cases. It can also result from acute changes associated with

and

. Other EKG signs include a

right bundle branch block A right bundle branch block (RBBB) is a heart block in the Bundle branches#Structure, right bundle branch of the Electrical conduction system of the heart, electrical conduction system. During a right bundle branch block, the right ventricle (h ...

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." Aside from echo and ECG, RV strain is visible with a

CT scan A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

of the chest and via cardiac magnetic resonance.

Notes

References

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External links

Right Ventricular Strain
ECG Library
Right Ventricular Strain & Failure
Video by Vanderbilt Emergency Medicine
McConnell sign and S1Q3T3 pattern in pulmonary embolism: revisited
__NOTOC__ Medical imaging

See also

Notes

References

External links