Clinical Signs and Electrocardiography

  • Elisabeta Bădilă


Right ventricular failure is a complex clinical syndrome that can result from any structural or functional cardiovascular disorder that impairs the ability of the right ventricle to fill or to eject blood. The approach to the patient with known or suspected right heart pathology begins with a directed history and targeted physical examination, the scope of which depends on the clinical context at the time of presentation. These exams are augmented by a series of paraclinic tests that help to accurately establish etiology and classify severity. Symptoms of right heart disease are often due to the underlying disease and depend on the severity of the condition. In acute life threatening situations, i.e. acute pulmonary embolism or right ventricular myocardial infarction, the clinical presentation may be dominated by hemodynamic instability even progressing to cardiogenic shock. The clinical signs encountered in patients with chronic right heart pathology are initially due to the development of pulmonary hypertension; afterwards, they are completed by the development of right ventricular hypertrophy and a typical picture of right ventricular failure, dominated by systemic congestion.

The electrocardiogram is a standard part of the initial assessment of every patient with suspected right heart failure and also in previously diagnosed patients presented for a routine examination or for a new decompensation. Right ventricular hypertrophy, right axis deviation, and right bundle-branch block may suggest chronic right ventricular pressure overload. The sensitivity of the ECG for the diagnosis of pulmonary hypertension is poor, whereas the specificity of signs of right ventricular hypertrophy is high. Electrocardiographic changes do not correlate with disease severity or prognosis.


Right ventricular failure Right ventricular hypertrophy Pulmonary hypertension Systemic congestion Electrocardiography in right heart disease 


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Elisabeta Bădilă
    • 1
    • 2
  1. 1.“Carol Davila” University of Medicine and PharmacyBucharestRomania
  2. 2.Internal Medicine DepartmentClinical Emergency Hospital BucharestBucharestRomania

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