Hello. My question has to do with echocardiograms and the diagnosis of right sided heart failure. I've heard that an echo is no good for diagnosing right-sided heart failure or muscle weaknesses in the right side of the heart. Is this true? If so, what test is needed to diagnose right side heart muscle problems? I'm confused because I thought an echo could give you an estimate of your ejection fraction and if it's normal, that basically means your entire heart (not just the left side) is healthy. Please clarify. Thank you.
Dear Kristine, thank you for your question. Right heart failure (RHF) is a clinical diagnosis that doesn't necessarily involve the right ventricle. The left ventricle fails in congestive heart failure and classic symptoms like shortness of breath develop. When congestive heart failure develops, excess fluid builds up in the lungs, which raises the blood pressure in the pulmonary arteries (which take blood from the right ventricle to the lungs). As the pulmonary artery pressures increase, the right ventricular pressure increases and the right ventricle dilates because it is a thin-walled structure that is used to very low pressures in a normal functioning heart. As the right ventricle dilates, it contractility is reduced and therefore, fluid returning from the venous system is not "pushed" through the right side of the heart well and backs up. When this happens, fluid accumulates in the legs (edema), abdomen (ascites), and liver (hepatomegaly). This triad of signs is diagnostic of right heart failure. However, there are primary disorders of the right ventricle and pulmonary arteries where right heart failure develops with a normal functioning left ventricle (primary pulmonary hypertension, constrictive pericarditis, infiltrative cardiomyopathies like amyloidosis, and certain congenital cardiac defects). Echocardiography can sometimes accurately determine right ventricular function when the images are good, but in many patients, the images are suboptimal due to body size, the positioning of the heart in the thorax, and lung diseases. The ejection fraction is only calculated for the LV on an echocardiogram because usually, only a subjective assessment of RV function is necessary. When the right ventricular pressure increases, the tricuspid valve separating the right atrium and ventricle leaks. We can measure the right ventricular pressure with an echocardiogram by determining the severity of tricuspid regurgitation. When an accurate determination of RV ejection fraction is needed, a MUGA scan or a cardiac MRI is needed. Additionally, a right heart catheterization can be done to precisely measure the right heart pressures and cardiac output. This test involves inserting a catheter into the right side of the heart. Thus, I hope this information answers your question - there are multiple testing modalities that can be done to assess right heart function, but the diagnosis of right heart failure should be made from clinical signs. Information provided in the heart forum is for general purposes only. Only your doctor can make specific diagnoses and therapies.
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