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Right Heart Stress Echocardiography

  • Chapter
Stress Echocardiography

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Abstract

The behavior of the right side of the heart during stress has been underemphasized and sparsely investigated by cardiologists and pneumologists. Reasons vary, but the right ventricle has traditionally been considered a passive conduit between the venous system and the lungs largely because of early animal experiments showing no increase of central venous pressure after the free wall of the right ventricle had been destroyed [1–3]. In addition, echocardiography of the right heart is less well standardized [4] as imaging of the left ventricle. Recent pathophysiological, clinical, and prognostic data have defined an important role for the right ventricle in many conditions, including ischemic heart disease and heart failure. Given that the right ventricle and the left ventricle share a common septum, have an overlapping blood supply, and are bound together by the pericardium, changes induced by myocardial ischemia and/or heart failure are reflected in pulmonary hemodynamics and right ventricular function [5]. Modern Doppler echocardiography allows a systematic evaluation of five key aspects of cardiopulmonary pathophysiology during stress: segmental right ventricular function; global right ventricular longitudinal function; coronary flow reserve in the posterior descending of the right coronary artery; indices of pulmonary hemodynamics, namely, pulmonary artery systolic pressure, pulmonary velocity time integrals, and pulmonary vascular resistances; and extravascular lung water in the lung, mirroring the distress of the alveolar–capillary membrane. Technical improvements were also matched by a greater understanding of the complexity and the clinical relevance of the adaptation of the right heart (functionally including pulmonary circulation and lung alveolar–capillary membrane) in several pathological conditions, from coronary artery disease to heart failure [5]. In many situations, it is not possible to fully understand heart disease if we do not look at the right heart and pulmonary stress hemodynamics.

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Authors and Affiliations

  1. Medical College of Wisconsin, Milwaukee, WI, USA

    Ekkehard Grunig PhD

  2. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA

    Eugenio Picano PhD

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  1. Ekkehard Grunig PhD
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Correspondence to Ekkehard Grunig PhD .

Table of Contents Video Companion

Table of Contents Video Companion

  • See in the section illustrative cases: case number 29 (diastolic dysfunction by Maria Joao Andrade MD, Carnaxide–Lisbon, Portugal), case number 31 (comets during exercise stress in heart failure patient), and case numbers 32–35 (pulmonary pressure in aortic stenosis).

  • See also in the section selected presentations: B-lines, in and out the stress echo lab.

  • Springer Extra Materials available at http://extras.springer.com/2015/978-3-319-20957-9

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Grunig, E., Picano, E. (2015). Right Heart Stress Echocardiography. In: Stress Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-319-20958-6_8

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