Right ventricular dysfunction

Last revised by Yuranga Weerakkody on 30 Nov 2021

Right ventricular dysfunction usually results from either pressure overload, volume overload, or a combination. 

It occurs in a number of clinical scenarios, including:

It can manifest as right heart strain.

Sustained right ventricular dilatation and hypertrophy can frequently progress to right ventricular failure.

Right ventricular dysfunction can comprise of

Two dimensional echocardiography is usually considered the mainstay for analysis of right ventricular function. 

Features include

  • right ventricular wall can be thickened (>4 mm) (often observed in congenital heart disease) or dilated (in acquired heart disease)
  • free wall may be hypokinetic; this is best appreciated on parasternal long axis projections

May have a role in assessment. Suggestive signs include:

  • right ventricular dilatation (RVD) (RV/LV ratio, >0.9) 5

Several phenotypic patterns have been described 9.

  1. pressure overload
  2. volume overload
  3. volume overload plus left ventricular dysfunction: considered 2nd commonest pattern
  4. depressed biventricular function: commonest pattern
  5. mixed overload, as there is co-existing biventricular dysfunction (in different degrees depending on disease duration), dilatation and right ventricular hypertrophy

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Cases and figures

  • Case 1: due to acute pulmonary embolism
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