Right heart

A breathless patient with completely normal diastolic parameters at rest may still have exercise induced raised pressures, and if the suspicion is high, a diastolic stress echo or an invasive assessment can settle the question.

Our listeners are very interested in my next question: the right heart.

The right ventricle is often neglected, but it predicts outcome in almost every condition: pulmonary embolism, pulmonary hypertension, heart failure, and after cardiac surgery.

First, size.

Other signs increase the probability: a flattened septum, a dilated right ventricle and pulmonary artery, a short pulmonary acceleration time, and a dilated IVC.

But remember, echo only estimates the probability.

The diagnosis of pulmonary hypertension requires right heart catheterization, and a useful marker of how well the right ventricle is coping is the ratio of TAPSE to the pulmonary systolic pressure.

A value below about 0.55 millimeters per millimeter of mercury indicates poor right ventricular to pulmonary arterial coupling and a worse outcome.