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16.06.2017 | Point of Care Thoracic Ultrasound (S Koenig, Section Editor)

The Right Ventricle in Cardiorespiratory Failure

verfasst von: Shannon M. Fernando, Scott J. Millington

Erschienen in: Current Pulmonology Reports | Ausgabe 3/2017

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Abstract

Purpose of Review

Thorough evaluation of the hypotensive or dyspneic patient requires an understanding of the physiology and common pathologies that relate to the right ventricle (RV). This review focuses on the role of point-of-care ultrasound (PoCUS) in evaluating the RV and discusses common clinical scenarios where PoCUS provides value.

Recent Findings

There are several signs of underlying RV pathology that can be detected using PoCUS; these including alterations in RV size, wall thickness, interventricular septal deviation, and RV function. These indicators help in differentiating between acute and chronic RV dysfunction. Recent findings include the role of more advanced and quantitative measures such as TAPSE, including their use in complex clinical situations such as acute cor pulmonale.

Summary

PoCUS can be used to supplement the history and physical examination in critically ill patients, specifically in the evaluation of RV dysfunction. This bedside tool is a valuable aid in guiding both diagnosis and management.
Literatur
1.
Zurück zum Zitat Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 2005;294(15):1944–56.CrossRefPubMed Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 2005;294(15):1944–56.CrossRefPubMed
2.
Zurück zum Zitat Rich JD, Rich S. Clinical diagnosis of pulmonary hypertension. Circulation. 2014;130(20):1820–30.CrossRefPubMed Rich JD, Rich S. Clinical diagnosis of pulmonary hypertension. Circulation. 2014;130(20):1820–30.CrossRefPubMed
3.
Zurück zum Zitat Wilcox SR, Kabrhel C, Channick RN. Pulmonary hypertension and right ventricular failure in emergency medicine. Ann Emerg Med. 2015;66(6):619–28.CrossRefPubMed Wilcox SR, Kabrhel C, Channick RN. Pulmonary hypertension and right ventricular failure in emergency medicine. Ann Emerg Med. 2015;66(6):619–28.CrossRefPubMed
4.
Zurück zum Zitat Woods J, Monteiro P, Rhodes A. Right ventricular dysfunction. Curr Opin Crit Care. 2007;13(5):532–40.PubMed Woods J, Monteiro P, Rhodes A. Right ventricular dysfunction. Curr Opin Crit Care. 2007;13(5):532–40.PubMed
5.
Zurück zum Zitat Price LC, Wort SJ, Finney SJ, Marino PS, Brett SJ. Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review. Crit Care. 2010;14(5):R169.CrossRefPubMedPubMedCentral Price LC, Wort SJ, Finney SJ, Marino PS, Brett SJ. Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review. Crit Care. 2010;14(5):R169.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Millington SJ, Arntfield RT. Advanced point-of-care cardiac ultrasound examination: Doppler applications, valvular assessment, and advanced right heart examination. Glob Heart. 2013;8(4):305–12.CrossRefPubMed Millington SJ, Arntfield RT. Advanced point-of-care cardiac ultrasound examination: Doppler applications, valvular assessment, and advanced right heart examination. Glob Heart. 2013;8(4):305–12.CrossRefPubMed
7.
Zurück zum Zitat Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685–713.CrossRefPubMed Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685–713.CrossRefPubMed
8.
Zurück zum Zitat Jardin F, Dubourg O, Bourdarias JP. Echocardiographic pattern of acute cor pulmonale. Chest. 1997;111(1):209–17.CrossRefPubMed Jardin F, Dubourg O, Bourdarias JP. Echocardiographic pattern of acute cor pulmonale. Chest. 1997;111(1):209–17.CrossRefPubMed
9.
Zurück zum Zitat Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7(2):79–108.CrossRefPubMed Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7(2):79–108.CrossRefPubMed
10.
Zurück zum Zitat Matsukubo H, Matsuura T, Endo N, Asayama J, Watanabe T. Echocardiographic measurement of right ventricular wall thickness. A new application of subxiphoid echocardiography. Circulation. 1977;56(2):278–84.CrossRefPubMed Matsukubo H, Matsuura T, Endo N, Asayama J, Watanabe T. Echocardiographic measurement of right ventricular wall thickness. A new application of subxiphoid echocardiography. Circulation. 1977;56(2):278–84.CrossRefPubMed
11.
Zurück zum Zitat Bleeker GB, Steendijk P, Holman ER, Yu CM, Breithardt OA, Kaandorp TA, et al. Acquired right ventricular dysfunction. Heart. 2006;92(Suppl 1):i14–8.CrossRefPubMedPubMedCentral Bleeker GB, Steendijk P, Holman ER, Yu CM, Breithardt OA, Kaandorp TA, et al. Acquired right ventricular dysfunction. Heart. 2006;92(Suppl 1):i14–8.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Weyman AE, Wann S, Feigenbaum H, Dillon JC. Mechanism of abnormal septal motion in patients with right ventricular volume overload: a cross-sectional echocardiographic study. Circulation. 1976;54(2):179–86.CrossRefPubMed Weyman AE, Wann S, Feigenbaum H, Dillon JC. Mechanism of abnormal septal motion in patients with right ventricular volume overload: a cross-sectional echocardiographic study. Circulation. 1976;54(2):179–86.CrossRefPubMed
13.
Zurück zum Zitat Lindqvist P, Waldenstrom A, Henein M, Morner S, Kazzam E. Regional and global right ventricular function in healthy individuals aged 20-90 years: a pulsed Doppler tissue imaging study: Umea General Population Heart Study. Echocardiography. 2005;22(4):305–14.CrossRefPubMed Lindqvist P, Waldenstrom A, Henein M, Morner S, Kazzam E. Regional and global right ventricular function in healthy individuals aged 20-90 years: a pulsed Doppler tissue imaging study: Umea General Population Heart Study. Echocardiography. 2005;22(4):305–14.CrossRefPubMed
14.
Zurück zum Zitat Tamborini G, Pepi M, Galli CA, Maltagliati A, Celeste F, Muratori M, et al. Feasibility and accuracy of a routine echocardiographic assessment of right ventricular function. Int J Cardiol. 2007;115(1):86–9.CrossRefPubMed Tamborini G, Pepi M, Galli CA, Maltagliati A, Celeste F, Muratori M, et al. Feasibility and accuracy of a routine echocardiographic assessment of right ventricular function. Int J Cardiol. 2007;115(1):86–9.CrossRefPubMed
15.
Zurück zum Zitat Tannus-Silva DG, Rabahi MF. State of the art review of the right ventricle in COPD patients: it is time to look closer. Lung. 2017;195(1):9–17. Tannus-Silva DG, Rabahi MF. State of the art review of the right ventricle in COPD patients: it is time to look closer. Lung. 2017;195(1):9–17.
16.
Zurück zum Zitat Vonk-Noordegraaf A, Marcus JT, Holverda S, Roseboom B, Postmus PE. Early changes of cardiac structure and function in COPD patients with mild hypoxemia. Chest. 2005;127(6):1898–903.CrossRefPubMed Vonk-Noordegraaf A, Marcus JT, Holverda S, Roseboom B, Postmus PE. Early changes of cardiac structure and function in COPD patients with mild hypoxemia. Chest. 2005;127(6):1898–903.CrossRefPubMed
17.
Zurück zum Zitat Sabit R, Bolton CE, Fraser AG, Edwards JM, Edwards PH, Ionescu AA, et al. Sub-clinical left and right ventricular dysfunction in patients with COPD. Respir Med. 2010;104(8):1171–8.CrossRefPubMed Sabit R, Bolton CE, Fraser AG, Edwards JM, Edwards PH, Ionescu AA, et al. Sub-clinical left and right ventricular dysfunction in patients with COPD. Respir Med. 2010;104(8):1171–8.CrossRefPubMed
18.
Zurück zum Zitat Hilde JM, Skjorten I, Grotta OJ, Hansteen V, Melsom MN, Hisdal J, et al. Right ventricular dysfunction and remodeling in chronic obstructive pulmonary disease without pulmonary hypertension. J Am Coll Cardiol. 2013;62(12):1103–11.CrossRefPubMed Hilde JM, Skjorten I, Grotta OJ, Hansteen V, Melsom MN, Hisdal J, et al. Right ventricular dysfunction and remodeling in chronic obstructive pulmonary disease without pulmonary hypertension. J Am Coll Cardiol. 2013;62(12):1103–11.CrossRefPubMed
19.
Zurück zum Zitat Dell’Italia LJ, Starling MR, O’Rourke RA. Physical examination for exclusion of hemodynamically important right ventricular infarction. Ann Intern Med. 1983;99(5):608–11.CrossRefPubMed Dell’Italia LJ, Starling MR, O’Rourke RA. Physical examination for exclusion of hemodynamically important right ventricular infarction. Ann Intern Med. 1983;99(5):608–11.CrossRefPubMed
20.
Zurück zum Zitat Kozakova M, Palombo C, Distante A. Right ventricular infarction: the role of echocardiography. Echocardiography. 2001;18(8):701–7.CrossRefPubMed Kozakova M, Palombo C, Distante A. Right ventricular infarction: the role of echocardiography. Echocardiography. 2001;18(8):701–7.CrossRefPubMed
21.
Zurück zum Zitat Goldberger JJ, Himelman RB, Wolfe CL, Schiller NB. Right ventricular infarction: recognition and assessment of its hemodynamic significance by two-dimensional echocardiography. J Am Soc Echocardiogr. 1991;4(2):140–6.CrossRefPubMed Goldberger JJ, Himelman RB, Wolfe CL, Schiller NB. Right ventricular infarction: recognition and assessment of its hemodynamic significance by two-dimensional echocardiography. J Am Soc Echocardiogr. 1991;4(2):140–6.CrossRefPubMed
22.
Zurück zum Zitat Engstrom AE, Vis MM, Bouma BJ, van den Brink RB, Baan J Jr, Claessen BE, et al. Right ventricular dysfunction is an independent predictor for mortality in ST-elevation myocardial infarction patients presenting with cardiogenic shock on admission. Eur J Heart Fail. 2010;12(3):276–82.CrossRefPubMed Engstrom AE, Vis MM, Bouma BJ, van den Brink RB, Baan J Jr, Claessen BE, et al. Right ventricular dysfunction is an independent predictor for mortality in ST-elevation myocardial infarction patients presenting with cardiogenic shock on admission. Eur J Heart Fail. 2010;12(3):276–82.CrossRefPubMed
23.
Zurück zum Zitat Villar J, Slutsky AS. GOLDEN anniversary of the acute respiratory distress syndrome: still much work to do! Curr Opin Crit Care. 2017;23(1):4–9.CrossRefPubMed Villar J, Slutsky AS. GOLDEN anniversary of the acute respiratory distress syndrome: still much work to do! Curr Opin Crit Care. 2017;23(1):4–9.CrossRefPubMed
24.
Zurück zum Zitat Lazzeri C, Cianchi G, Bonizzoli M, Batacchi S, Peris A, Gensini GF. The potential role and limitations of echocardiography in acute respiratory distress syndrome. Ther Adv Respir Dis. 2016;10(2):136–48.CrossRefPubMed Lazzeri C, Cianchi G, Bonizzoli M, Batacchi S, Peris A, Gensini GF. The potential role and limitations of echocardiography in acute respiratory distress syndrome. Ther Adv Respir Dis. 2016;10(2):136–48.CrossRefPubMed
25.
Zurück zum Zitat Repesse X, Charron C, Vieillard-Baron A. Acute cor pulmonale in ARDS: rationale for protecting the right ventricle. Chest. 2015;147(1):259–65.CrossRefPubMed Repesse X, Charron C, Vieillard-Baron A. Acute cor pulmonale in ARDS: rationale for protecting the right ventricle. Chest. 2015;147(1):259–65.CrossRefPubMed
26.
Zurück zum Zitat • Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F. Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med. 2002;166(10):1310–9. Evidence supporting bedside utilization of PoCUS to detect acute RV dysfunction in critically ill patients CrossRefPubMed • Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F. Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med. 2002;166(10):1310–9. Evidence supporting bedside utilization of PoCUS to detect acute RV dysfunction in critically ill patients CrossRefPubMed
27.
Zurück zum Zitat Legras A, Caille A, Begot E, Lheritier G, Lherm T, Mathonnet A, et al. Acute respiratory distress syndrome (ARDS)-associated acute cor pulmonale and patent foramen ovale: a multicenter noninvasive hemodynamic study. Crit Care. 2015;19:174.CrossRefPubMedPubMedCentral Legras A, Caille A, Begot E, Lheritier G, Lherm T, Mathonnet A, et al. Acute respiratory distress syndrome (ARDS)-associated acute cor pulmonale and patent foramen ovale: a multicenter noninvasive hemodynamic study. Crit Care. 2015;19:174.CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Mayo PH, Narasimhan M, Koenig S. Critical care transesophageal echocardiography. Chest. 2015;148(5):1323–32.CrossRefPubMed Mayo PH, Narasimhan M, Koenig S. Critical care transesophageal echocardiography. Chest. 2015;148(5):1323–32.CrossRefPubMed
29.
Zurück zum Zitat Reynolds HR, Jagen MA, Tunick PA, Kronzon I. Sensitivity of transthoracic versus transesophageal echocardiography for the detection of native valve vegetations in the modern era. J Am Soc Echocardiogr. 2003;16(1):67–70.CrossRefPubMed Reynolds HR, Jagen MA, Tunick PA, Kronzon I. Sensitivity of transthoracic versus transesophageal echocardiography for the detection of native valve vegetations in the modern era. J Am Soc Echocardiogr. 2003;16(1):67–70.CrossRefPubMed
31.
Zurück zum Zitat Seif D, Meeks A, Mailhot T, Perera P. Emergency department diagnosis of infective endocarditis using bedside emergency ultrasound. Crit Ultrasound J. 2013;5(1):1.CrossRefPubMedPubMedCentral Seif D, Meeks A, Mailhot T, Perera P. Emergency department diagnosis of infective endocarditis using bedside emergency ultrasound. Crit Ultrasound J. 2013;5(1):1.CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Al-Hamrashdi B, Valiani S, Khan N, Mansour M, Millington SJ. Right- and left-sided embolic phenomena in a patient with febrile neutropenia. Chest. 2016;149(6):e173–5.CrossRefPubMed Al-Hamrashdi B, Valiani S, Khan N, Mansour M, Millington SJ. Right- and left-sided embolic phenomena in a patient with febrile neutropenia. Chest. 2016;149(6):e173–5.CrossRefPubMed
33.
Zurück zum Zitat Sanfilippo AJ, Picard MH, Newell JB, Rosas E, Davidoff R, Thomas JD, et al. Echocardiographic assessment of patients with infectious endocarditis: prediction of risk for complications. J Am Coll Cardiol. 1991;18(5):1191–9.CrossRefPubMed Sanfilippo AJ, Picard MH, Newell JB, Rosas E, Davidoff R, Thomas JD, et al. Echocardiographic assessment of patients with infectious endocarditis: prediction of risk for complications. J Am Coll Cardiol. 1991;18(5):1191–9.CrossRefPubMed
35.
Zurück zum Zitat • Koenig S, Chandra S, Alaverdian A, Dibello C, Mayo PH, Narasimhan M. Ultrasound assessment of pulmonary embolism in patients receiving CT pulmonary angiography. Chest. 2014;145(4):818–23. This study provides evidence that PE detected by PoCUS does not require CT chest for confirmation CrossRefPubMed • Koenig S, Chandra S, Alaverdian A, Dibello C, Mayo PH, Narasimhan M. Ultrasound assessment of pulmonary embolism in patients receiving CT pulmonary angiography. Chest. 2014;145(4):818–23. This study provides evidence that PE detected by PoCUS does not require CT chest for confirmation CrossRefPubMed
36.
Zurück zum Zitat Nazerian P, Vanni S, Volpicelli G, Gigli C, Zanobetti M, Bartolucci M, et al. Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism. Chest. 2014;145(5):950–7.CrossRefPubMed Nazerian P, Vanni S, Volpicelli G, Gigli C, Zanobetti M, Bartolucci M, et al. Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism. Chest. 2014;145(5):950–7.CrossRefPubMed
37.
Zurück zum Zitat •• Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest. 2015;147(6):1659–70. This study outlines the BLUE protocol, a systematic PoCUS approach to the dyspneic patient CrossRefPubMed •• Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest. 2015;147(6):1659–70. This study outlines the BLUE protocol, a systematic PoCUS approach to the dyspneic patient CrossRefPubMed
38.
Zurück zum Zitat Bova C, Greco F, Misuraca G, Serafini O, Crocco F, Greco A, et al. Diagnostic utility of echocardiography in patients with suspected pulmonary embolism. Am J Emerg Med. 2003;21(3):180–3.CrossRefPubMed Bova C, Greco F, Misuraca G, Serafini O, Crocco F, Greco A, et al. Diagnostic utility of echocardiography in patients with suspected pulmonary embolism. Am J Emerg Med. 2003;21(3):180–3.CrossRefPubMed
Metadaten
Titel
The Right Ventricle in Cardiorespiratory Failure
verfasst von
Shannon M. Fernando
Scott J. Millington
Publikationsdatum
16.06.2017
Verlag
Springer US
Erschienen in
Current Pulmonology Reports / Ausgabe 3/2017
Elektronische ISSN: 2199-2428
DOI
https://doi.org/10.1007/s13665-017-0183-y

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