Right ventricular dysfunction

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

It occurs in a number of clinical scenarios, including:

• pressure overload  

• cardiomyopathies: ischemic, congenital

• valvular heart disease

• arrhythmias

• sepsis

It can manifest as right heart strain.

Pathology

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

Right ventricular dysfunction can comprise of

• right ventricular systolic dysfunction

• right ventricular diastolic dysfunction

• combination

Radiographic features

Echocardiography

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

CT

May have a role in assessment. Suggestive signs include:

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

MRI

Several phenotypic patterns have been described ⁹.

1. pressure overload

2. volume overload

3. volume overload plus left ventricular dysfunction: considered 2^nd 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

See also

• right ventricle