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Right Ventricular Dysfunction: Causes, Symptoms, and Treatment

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Right ventricular dysfunction is a condition in which the right ventricle functions poorly, leading to other complications. Read the article to know more.

Medically reviewed by

Dr. Muhammad Zohaib Siddiq

Published At March 15, 2023
Reviewed AtMarch 15, 2023

Introduction

The heart is the powerhouse of the circulatory system. It continuously moves blood throughout the body, providing oxygenated blood and nutrients to the other organs while also returning the deoxygenated blood to the lungs. A muscular organ, the heart has four chambers, namely atria (upper two chambers) and ventricles (lower two chambers), with one of each present on either side of the heart. The atria helps the ventricle fully load up before it ejects the blood away from the heart.

What Is the Right Ventricle and What Are Its Functions?

The right ventricle is the right lower chamber of the heart. It is a semilunar or crescent-shaped chamber (seen on the transverse section of the heart) and is responsible for pumping blood to the lungs through the pulmonary trunk. The pulmonary trunk, otherwise known as the pulmonary artery, is a blood vessel arising from the base of the right lower heart chamber, splitting into the right and left pulmonary arteries. It then carries deoxygenated blood to the lungs, where it gets oxygenated. The right ventricle wall is thin as it pumps blood only to the lungs, whereas the left ventricle wall is much thicker because it has high pressure as it pumps blood to the entire body via the aorta. An interventricular septum separates both the right and left ventricles.

What Is Right Ventricular (RV) Dysfunction?

Right ventricular (RV) dysfunction is a medical condition in which the stroke volume increases even if there is an increased right ventricular (RV) end-diastolic volume. In simple words, it means an increase in the volume of blood pumped out of the left ventricle (LV) during each heart contraction (systole), even when there is an increase in the amount of blood within the ventricles when the heart contracts.

Is Right Ventricular (RV) Dysfunction the Same as a Right Ventricular (RV) Failure?

A right ventricular (RV) dysfunction differs from a right ventricular (RV) failure. In a right ventricular (RV) failure, the stroke volume does not compensate or increase when there is an increase in the end-diastolic volume.

What Are the Symptoms Associated With Right Ventricular (RV) Dysfunction?

A right ventricular (RV) dysfunction can elicit the following symptoms:

  • Dyspnea (shortness of breath).

  • Chest pain.

  • Arrhythmias (irregular heartbeats).

  • Cyanosis (bluish discoloration of fingertips and lips).

  • Swelling of the lower extremities (especially ankles and feet).

  • Lightheadedness.

  • Unusual fatigue or tiredness.

  • Fatigue and episodes of fainting during exercise or strenuous activity.

What Are the Causes of Right Ventricular (RV) Dysfunction?

Right ventricular (RV) dysfunction begins with an injury or stress to the tissues of the heart (myocardium). It can be conceptualized as a problem of poor contractility, pressure, volume overload, or a combination of the three. There are numerous causes for right ventricular (RV) dysfunction, such as:

  • Chronic Left-Sided Heart Failure - A heart condition in which the left heart fails to efficiently pump blood to the body.

  • Pulmonary Hypertension - A pulmonary hypertension is a critical condition wherein the pressure within the blood vessels associated with the heart and lungs is abnormally high.

  • Pulmonary Emboli - A condition in which the blood vessel in the lungs gets blocked, usually by a blood clot.

  • Tricuspid Regurgitation - A valvular heart disease wherein the valve present between the upper and lower right chambers of the heart fails to close properly.

  • Hypoventilation - Otherwise known as respiratory depression, it is a condition wherein an individual is unable to breathe properly, necessitating respiratory gas exchange.

  • Tetralogy of Fallot - A congenital heart disease characterized by four different forms of defects.

  • Transposition of the Great Arteries - A condition of the blood vessels associated with the heart, characterized by the switching in their anatomical positions.

  • Ebstein’s Anomaly - A type of congenital heart disorder associated with the tricuspid valve.

  • Eisenmenger Syndrome - A Eisenmenger syndrome is a syndrome that is characteristic of inefficient and improper blood flow in the lungs and heart.

How Is Right Ventricular (RV) Dysfunction Diagnosed?

Along with physical examination, several methods are available to assess the functioning of the right ventricle, such as:

  • Cardiovascular Resonance Imaging (CMR): Also referred to as the cardiac magnetic resonance imaging (MRI) test, is the standard gold test for the evaluation of the right ventricle. Magnetic and radio waves create detailed images of the heart and its associated structures.

  • Electrocardiogram (EKG or ECG): ECG is a rapid and painless test that assesses different heart conditions by recording electrical signals from the heart. Having multiple electrodes (otherwise known as tiny sensors) stuck to different parts of the body, recording the electrical conduction within the heart, which helps identify the extra heartbeats and helps locate the origin of the extra heartbeat too.

  • Cardiac Catheterization: Cardiac catheterization or a traditional angiogram, has been a gold standard test for assessing the health of a human heart. It is an invasive technique that involves passing a catheter into the blood vessels (arteries). At times, doctors may advise a ‘contrast angiography.’ It consists of the use of a special dye, which is injected for the amplification of the images.

  • Transthoracic Echocardiogram (TTE): A test that helps examine the heart’s irregularities and associated structures with the help of ultrasound.

  • Stress Test: A stress test is used for the analysis of the heart’s response when it is functioning at its peak, for instance, during an intense level of activity. It is done using an electrocardiogram and exercise devices such as a stationary bike.

  • Cardiac CT-Scan or Cardiac Computed Tomography Scan: A non-invasive diagnostic imaging procedure that shows detailed images of the heart and its associated structures, such as blood vessels and valves. It gives more comprehensive scans when compared to those of traditional angiograms. Doctors may sometimes advise a ‘contrast cardiac CT scan.

How Is a Right Ventricular (RV) Dysfunction Treated?

Management of a right ventricular (RV) dysfunction is done in several stages and is an amalgamation of percutaneous intervention for treatable causes, physical rehabilitation, and drug therapy. In the most severe cases, surgical intervention to place devices that aids proper functioning of the heart, or heart transplantation can also be done.

The main treatment goals are:

  • To Increase the Contractility of the (RV) Right Ventricle - This is done with the help of medications, increased oxygen supply, and exercise training.

  • Decrease the Volume Overload - Medications such as Aldosterone, loop diuretics, etc., help to do so. Surgical interventions include the closure of the shunts.

  • Decrease the Right Ventricular (RV) Pressure Overload - In severe cases, it can be managed by a procedure called ‘balloon dilation atrial septostomy (BDAS).’

What Are the Complications Associated With Right Ventricular (RV) Dysfunction?

If not treated, right ventricular (RV) dysfunction can lead to right ventricular (RV) failure (either eventually over the years or acutely). Right ventricular (RV) failure eventually leads to pulmonary arterial hypertension (PAH).

Conclusion

Right ventricular (RV) dysfunction is a condition in which the right ventricle does not function properly, leading to further complications. It can be caused due to various reasons and has a good prognosis if intervened timely. it can be easily diagnosed through various methods such as ECG and cardiac CT scan. Certain medications helps in increasing the oxygen supply. proper care and regular checkups helps in bettering this condition.

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Dr. Muhammad Zohaib Siddiq
Dr. Muhammad Zohaib Siddiq

Cardiology

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