Test yourself
RV strain: three clues beat one ratio
4 questions. Pick an answer to see whether you are right and why. Your score appears at the end.
Question 1In the apical four-chamber view, what is the normal size of the right ventricle relative to the left?
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Answer d. A normal right ventricle measures about two thirds of the left at the base, or less. Equal to or larger than the left counts as dilated.
Question 2What does a D-shaped left ventricle in parasternal short axis indicate?
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Answer c. When pressure in the right ventricle rises, the septum flattens towards the left ventricle and its round cross-section becomes a D.
Question 3The right ventricle is dilated with a free wall of 8 mm. What does the wall thickness suggest?
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Answer d. A previously normal right ventricle cannot generate high pressures quickly and stays thin-walled when it dilates. Over 5 mm suggests hypertrophy from chronic pressure load.
Question 4A breathless patient has a normal right ventricle on bedside echo. What do you conclude about pulmonary embolism?
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Answer a. Many patients with pulmonary embolism, especially a small one, have a normal right ventricle. Use your clinical probability and the usual pathway.
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