There were no regions of focal RV akinesis or dyskinesis to suggest arrhythmogenic RV cardiomyopathy. The tricuspid regurgitant jet was consistent with a right ventricular systolic pressure within normal limits ruling out RV pressure overload.
The intra-atrial septum was not well seen, but there was no obvious atrial-level shunt. No obvious cause for RV volume loading was identified with structurally normal right-sided valves, only mild tricuspid regurgitation and trace pulmonary regurgitation. There was evidence of RV volume overload with no evidence of RV pressure overload ( Figure 2). Once a dilated RV was identified, the rest of the echocardiographic examination paid particular attention to identifying causes for his RV dilation ( Table 1). His TTE demonstrated a moderately dilated right ventricle (RV) based on qualitative assessment ( Figure 1). His ECG demonstrated sinus rhythm with an incomplete right bundle branch block.Ī transthoracic echocardiogram (TTE) was performed to assess for structural heart disease given his episode of atrial flutter, physical examination, and ECG findings. In sinus rhythm, he was asymptomatic, and his physical examination demonstrated no jugular venous distention, a fixed split second heart sound, and a I/VI early peaking systolic ejection murmur loudest over the left upper sternal border. He spontaneously converted to sinus rhythm in the emergency department.
Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.
Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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