From the Guidelines
A right ventricular lift is caused by right ventricular hypertrophy or enlargement, which occurs when the right ventricle of the heart has to work harder against increased pressure in the pulmonary circulation, as evidenced by studies such as 1 and 1. The most common causes of right ventricular lift include:
- Pulmonary hypertension
- Pulmonary stenosis
- Right ventricular outflow tract obstruction
- Chronic lung diseases like COPD
- Pulmonary embolism
- Congenital heart defects such as atrial septal defect or ventricular septal defect When the right ventricle enlarges due to these conditions, it becomes more forceful in its contraction and can be felt as a palpable pulsation or lift at the left lower sternal border during physical examination, as described in 1 and 1. This occurs because the hypertrophied right ventricle pushes against the chest wall during contraction. The presence of a right ventricular lift is an important clinical finding that suggests significant right-sided heart pressure or volume overload and warrants further cardiac evaluation including echocardiography to determine the underlying cause and severity, as recommended in 1 and 1. It is essential to note that right ventricular dysfunction is associated with poor clinical outcomes, and accurate diagnosis is necessary to guide therapy, as highlighted in 1 and 1. Therefore, a comprehensive evaluation, including echocardiography and other diagnostic tests, is crucial to determine the underlying cause of right ventricular lift and to develop an effective treatment plan.
From the Research
Causes of Right Ventricular Lift
The right ventricular lift can be caused by various factors, including:
- RV volume overload, which can be due to congenital heart disease or valvular abnormalities 2
- RV pressure overload, which can be caused by pulmonary hypertension 2, 3, 4
- RV myocardial disease, which can be difficult to diagnose and may require the use of advanced imaging techniques such as two-dimensional speckle tracking 2
- Nonpathological RV dilatation, which can be caused by various factors such as increased preload or afterload 3
Mechanisms of Right Ventricular Lift
The mechanisms of right ventricular lift can be complex and involve various changes in the RV, including:
- Dilatation, which can be caused by increased preload 3
- Hypertrophy, which can be caused by increased afterload 3
- Changes in the shape of the RV, which can induce tricuspid regurgitation and superimpose changes of chamber dilatation onto those of hypertrophy 3
- Decreased RV systolic function, which can be associated with elevation of RV and right atrial diastolic pressure 3
Diagnostic Techniques
Various diagnostic techniques can be used to assess right ventricular lift, including:
- Transthoracic echocardiography (TTE), which can detect RV dilatation and valvular abnormalities 2
- Three-dimensional echocardiography, which can provide volumetric assessment and help determine intervention timing 2
- Multiplanar MR imaging, which can directly demonstrate changes in RV size and wall morphology 3
- Conventional contrast right ventriculography, which can assess the size and position of the RV, as well as associated acquired and congenital lesions 3