Right heart strain

Right heart strain (or more precisely right ventricular strain) is a term given to denote the presence of right ventricular dysfunction usually in the absence of an underlying cardiomyopathy. It can manifest as an acute right heart syndrome.

Right heart strain can often occur as a result of pulmonary arterial hypertension (and its underlying causes such as massive pulmonary emboli).

May have elevated levels of 4:

  • troponin
  • B-type natriuretic peptide (BNP)

The reported sensitivity and specificity of CT in demonstrating right heart dysfunction are around 81% and 47% respectively 5.

Described features include:

  • abnormal position of the interventricular septum 1
    • flattening of the interventricular septum
    • paradoxical interventricular septal bowing, i.e. towards the left ventricle
  • right ventricular enlargement (right ventricle bigger than the left ventricle)
  • pulmonary trunk enlargement (bigger than the aorta)
  • features of right heart failure
    • inferior vena caval contrast reflux 1
    • dilated azygous venous system
    • dilated hepatic veins +/- with contrast reflux

The reported sensitivity and specificity of echocardiography in demonstrating right heart dysfunction are around 56% and 42% respectively 5.

May show the above CT features +/- right ventricular hypokinesia.

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Article information

rID: 31600
Systems: Chest, Cardiac
Section: Gamuts
Synonyms or Alternate Spellings:
  • Right ventricular strain
  • RV strain

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Cases and figures

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    Massive bilateral...
    Case 1: in the setting of pulmonary emboli
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    Case 2: in the setting of saddle pulmonary emboli
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    Case 3: massive PE
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    Case 4: from cocaine toxicity
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