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The EF of the right heart, or right ventricular ejection fraction (RVEF), is a measure of the efficiency of pumping into the pulmonary circulation. A heart which cannot pump sufficient blood to meet the body's requirements (i.e., heart failure) will often, but not invariably, have a reduced ventricular ejection fraction.
Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to fill with and pump blood.. Although symptoms vary based on which side of the heart is affected, HF typically presents with shortness of breath, excessive fatigue, and bilateral leg swelling. [3]
Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure in which the ejection fraction – the percentage of the volume of blood ejected from the left ventricle with each heartbeat divided by the volume of blood when the left ventricle is maximally filled – is normal, defined as greater than 50%; [1] this may be measured by echocardiography or cardiac catheterization.
Kussmaul sign suggests impaired filling of the right ventricle due to a poorly compliant myocardium or pericardium. This impaired filling causes the increased blood flow to back up into the venous system, causing the jugular vein distention (JVD) and is seen clinically in the internal jugular veins becoming more readily visible. [citation needed]
An important potential finding with echo is McConnell's sign, where only the RV apex wall contracts; [7] it is specific for right heart strain and typically indicates a large PE. [8] On an electrocardiogram (ECG), there are multiple ways RV strain can be demonstrated. A finding of S1Q3T3 [b] is an insensitive [10] sign of right heart strain. [11]
In more severe cases it is a consequence of dilation of the right ventricle, leading to displacement of the papillary muscles which control the valve's ability to close. [13] Dilation of the right ventricle occurs secondary to ventricular septal defects, right to left shunting of blood, eisenmenger syndrome, hyperthyroidism, and pulmonary stenosis.
The progression of heart failure is associated with left ventricular remodeling, which manifests as gradual increases in left ventricular end-diastolic and end-systolic volumes, wall thinning, and a change in chamber geometry to a more spherical, less elongated shape. This process is usually associated with a continuous decline in ejection fraction
Bernheim syndrome is believed to be the rightward shift of the ventricular septum compressing the right ventricle without causing pulmonary congestion. [3] This was first described by Hippolyte Bernheim in which he presented 10 patients with signs and symptoms of right sided heart failure whose postmortem autospy reveals a ventricular septum that invaded the right ventricle space. [1]
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