![Pulm embolism](https://upload.wikimedia.org/wikipedia/commons/b/b2/Pulm_embolism.jpg)
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, myocardium, cardiomyocytes and cardiac myocytes) is one of three types of vertebrate muscle tissues, with the other two being skeletal muscle and smooth muscle. It is an involuntary, striated muscle tha ...
of the right ventricle (RV) is deformed. Right heart strain can be caused by
pulmonary hypertension,
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 p ...
(or PE, which itself can cause pulmonary hypertension
), RV
infarction
Infarction is tissue death (necrosis) due to inadequate blood supply to the affected area. It may be caused by artery blockages, rupture, mechanical compression, or vasoconstriction. The resulting lesion is referred to as an infarct
(from the ...
(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 failu ...
),
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
Cause
Pulmonic stenosis is usually due to isolated valvula ...
,
bronchospasm
Bronchospasm or a bronchial spasm is a sudden 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 anaphylatoxins. It causes di ...
, and
pneumothorax
A pneumothorax is an abnormal 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 shortness of breath. In a minority of cases, a one-way valve ...
.
When using an
echocardiograph (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
bronchospasm
Bronchospasm or a bronchial spasm is a sudden 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 anaphylatoxins. It causes di ...
and
pneumothorax
A pneumothorax is an abnormal 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 shortness of breath. In a minority of cases, a one-way valve ...
.
Other EKG signs include a
right bundle branch block
A right bundle branch block (RBBB) is a heart block in the right bundle branch of the electrical conduction system.
During a right bundle branch block, the right ventricle is not directly activated by impulses travelling through the right bu ...
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 of the chest and via
cardiac magnetic resonance.
See also
*
Pulmonary heart disease
Pulmonary heart disease, also known as cor pulmonale, is the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance (such as from pulmonic stenosis) or high blood pressure in the lungs.
Chroni ...
(cor pulmonale)
*
Right heart failure
*
Hampton hump
Notes
References
{{reflist
External links
Right Ventricular StrainECG Library
Right Ventricular Strain & FailureVideo by Vanderbilt Emergency Medicine
McConnell sign and S1Q3T3 pattern in pulmonary embolism: revisited
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Medical imaging