II. Technique
- Best views to estimate right ventricular function
- Apical four chamber view
- Parasternal short axis
III. Imaging: Right ventricular dysfunction signs suggestive of increased right heart pressures
- Right ventricular dilation (RV diameter compared with LV) on apical four chamber view
- Right ventricle is normally 2/3 the size of the left ventricle
- Abnormal if RV is the same size or larger than the left ventricle
- Acute RV dilation findings (contrast with chronic RV dilation of COPD and other Cor Pulmonale)
- Right ventricular free wall thickness <0.5 cm in end diastole
- Right ventricular wall contractility decreased
- D-Shaped left ventricle (PSAX View)
- McConnell's Sign
- Dilated right ventricle with RV free wall akinesis and normal apical contractions
- Right ventricular apex contracts normally
- Right ventricular free wall does not contract
- Sosland (2008) Circulation 118(15):e517-8 +PMID:18838568 [PubMed]
- Flattening or paradoxical movement of the septum in PSAX View
- Inferior Vena Cava dilation
- 60/60 Sign
- Right ventricular outflow tract doppler flow acceleration time cut-off at <60 ms
- Pulmonary artery systolic pressure 30-60 mmHg
IV. Differential diagnosis: Echocardiogram with right heart dysfunction
- Chronic Pulmonary Hypertension
- Right ventricle wall thickness >0.5 cm
- Cardiac Tamponade
- Right-sided Myocardial Infarction
V. References
- Swaminathan, Valois and Lanctot in Herbert (2019) EM:Rap 19(6): 6-8
- Orman, Dawson and Mallin in Herbert (2013) EM:Rap 13(1): 4-6
- Swaminathan and Avila in Herbert (2020) EM:Rap 20(5):10