Transthoracic Right Heart Echocardiography for the Intensivist

Hockstein, Maxwell A. MD
Haycock, Korbin MD, RDMS, RDCS
Wiepking, Matthew MB, BMedSc, BCh, BAO
Lentz, Skyler MD
Dugar, Siddharth MD
Siuba, Matthew DO

¹Departments of Emergency Medicine and Critical Care, 8405MedStar Washington Hospital Center, Washington, DC, USA
²Department of Emergency Medicine, 4608Loma Linda University Medical Center, Loma Linda, CA, USA
³Department of Emergency Medicine and Surgery, 12223University of Southern California-Keck School of Medicine, Los Angeles, CA, USA
⁴Division of Emergency Medicine and Pulmonary Disease & Critical Care Medicine, Department of Surgery and Medicine, Larner College of 12352Medicine-University of Vermont, Burlington, VT, USA
⁵Department of Critical Care Medicine, Respiratory Institute, 2569Cleveland Clinic, Cleveland, OH, USA

Maxwell A. Hockstein, Departments of Emergency Medicine and Critical Care, MedStar Washington Hospital Center, 110 Irving st. NW, Washington, DC 20010, USA. Email: [email protected]

Received February 06, 2021

Received in revised form February 06, 2021

Accepted March 01, 2021

Journal of Intensive Care Medicine 36(9):p 1098-1109, September 2021. | DOI: 10.1177/08850666211003475

Background:

The impact of critical illness on the right ventricle (RV) can be profound and RV dysfunction is associated with mortality. Intensivists are becoming more facile with bedside echocardiography, however, pedagogy has largely focused on left ventricular function. Here we review measurements of right heart function by way of echocardiographic modalities and list clinical scenarios where the RV dysfunction is a salient feature.

Main:

RV dysfunction is heterogeneously defined across many domains and its diagnosis is not always clinically apparent. The RV is affected by conditions commonly seen in the ICU such as acute respiratory distress syndrome, pulmonary embolism, RV ischemia, and pulmonary hypertension. Basic ultrasonographic modalities such as 2D imaging, M-mode, tissue Doppler, pulsed-wave Doppler, and continuous Doppler provide clinicians with metrics to assess RV function and response to therapy.

Conclusion:

The right ventricle is impacted by various critical illnesses with substantial mortality and mortality. Focused bedside echocardiographic exams with attention to the right heart may provide intensivists insight into RV function and provide guidance for patient management.