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
- Septal bowing
- Tricuspid annular dilatation
- RV ejection fraction (Continues to be complex for routine usage )
TR jet
- Dp/Dt
- Morphology may be useful (Mainly for TR severity )
Tissue doppler
- TAPSE
- RV strain rate Imaging etc.
And now , we have observed a new echocardiographic sign ie TR jet alternans in patient with DCM .
Note the changing TR velocity implying severe RV contractile dysfunction.
Dr.S.Venkatesan MD 
Leave a Reply