How to assess the right ventricle using handheld ECHO

26th Nov 2020

Assessing right ventricle systolic function in patients with COVID-19

Disseminated microthrombosis has been found in patients infected with SARS-CoV-2. When these microclots occur in the pulmonary vasculature, they can result in pulmonary emboli. 

Acute pressure overload due to pulmonary emboli is poorly tolerated by the right ventricle, thus causing dilatation and strain. 

Focused right ventricular (RV) assessment of a patient with COVID-19 will typically demonstrate right ventricular dilatation and signs of right ventricular strain. This results from an increased RV afterload and increased pulmonary vascular resistance.

Echocardiograms showing right ventricle (RV) dilatation and strain in patients with COVID-19. Apical four-chamber and RV-focused views.

Figure 1. In patients with COVID-19, focused right ventricular assessments have shown signs of right ventricle (RV) dilatation and strain—the result of increased afterload and pulmonary vascular resistance due to pulmonary emboli caused by disseminated microthrombosis. 

Check out this short video clip from our COVID Mini: Handheld ECHO Course that highlights right ventricular dilatation and strain that can be seen in patients with COVID-19 and disseminated microthrombosis:

 

Right ventricular systolic function paired with the characteristic interventricular septal motion and inferior vena cava (IVC) dilatation are features to assess in a patient with COVID-19. Medmastery note.

 

Assessing interventricular septal motion in patients with COVID-19

Increased right ventricular pressure overload can be qualitatively assessed by examining the motion of the interventricular septum, which may exhibit paradoxical septal motion. 

Since the interventricular septum is a shared structure, the left ventricle may show signs of underfilling as the heart contracts in the confined space. Thus, underfilling of the left ventricle may result in the left atrium and left ventricle chambers appearing smaller. 

Echocardiograms highlighting the interventricular septum. Apical four-chamber and short-axis views.

Figure 2. In patients with COVID-19, increased right ventricular pressure overload can be identified by assessing the interventricular septum for paradoxical septal motion. As a result of the right heart overload, the left heart chambers may also appear smaller. PSAX, parasternal short-axis view.

Check out this short video clip from our COVID Mini: Handheld ECHO Course that highlights the paradoxical septal motion of the interventricular septum (and resulting decrease in size of left heart chambers) that can be seen in patients with COVID-19 and increased right ventricular pressure overload:

 

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Assessing right ventricular afterload in patients with COVID-19

Conversely, increased right ventricular afterload will cause right atrial pressure to increase. This leads to tricuspid regurgitation and a dilated, non-collapsing inferior vena cava (IVC).

Echocardiograms showing right ventricular afterload causing tricuspid regurgitation and dilated, non-collapsing inferior vena cava (IVC) in patients with COVID-19.

Figure 3. In patients with COVID-19, increased right ventricular afterload causes right atrial pressure to increase which leads to tricuspid regurgitation and a dilated, non-collapsing inferior vena cava (IVC). 

Check out this short video clip from our COVID Mini: Handheld ECHO Course that highlights the tricuspid regurgitation and non-collapsing, or dilated, IVC that can be seen in patients with COVID-19 and increased right ventricular afterload:

 

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Recommended reading

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