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 that ...

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 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 shortness of breath, chest pain particularly upon breathin ...

(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 th ...

(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 i ...

. 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

and

. 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.

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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

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