TR jet alternans : A new marker for severe RV dysfunction
Posted Nov 30 2012 12:03pm
Here is a patient with class 3 dyspnea who was referred for echocardiography
X ray chest showing cardiomegaly
Moderate TR due to dilatation of tricuspid annulus.This patient had dilatation of all 4 chambers of the heart.LV EF was 24 %
Right ventricular dysfunction is major determinant of clinical outcome in patients with dilated cardiomyopathy. The myocardium of the entire heart is now known to be a single sheet of muscle rolled into different chambers . So any primary disease of myocardium will involve the entire musculature . This is the reason , all the 4 chambers of heart goes for dilatation in primary cardiomyopathy . Of course there can be minor variations due to differential hemodynamic impact.
But it is certain , RV function will definitely be compromised In most patients with Idiopathic DCM (Less common in Ischemic DCM ) Rapid assessment of RV function is difficult . Of course We have some clues .
2 d Features
Simple dilatation of RV is suffice to say it is struggling with the loading conditions
Tricuspid annular dilatation
RV ejection fraction (Continues to be complex for routine usage )
Morphology may be useful (Mainly for TR severity )