Monday, February 8, 2016

TTE for RV Strain

emDocs – February 8, 2016 - By Manpreet Singh
Originally published at R.E.B.E.L. EM on April 7, 2015. By  Cirilli A.
"Abnormal vital signs are poor predictors of mortality associated with pulmonary embolism (PE). Diagnosis of PE and right ventricular (RV) strain with transthoracic echocardiography (TTE) however, has been well documented as a predictor for pending shock and significant in-hospital mortality. One study done by Grifoni S et al, showed that 10% of normotensive patients with PE and RV strain on echo developed PE related shock, and 3% died, whereas normotensive patients without signs of RV strain remained hemodynamically stable. 
  • Point of Care echo is very good for the detection of RV strain
  • In the setting of suspected PE, RV strain on echo is not sensitive for the prediction of PE but it is more specific.
  • In the setting of hemodynamic instability the detection of RV strain seems to be very specific for PE
  • The finding of a right heart thrombus in the setting of PE and RV strain doubles the mortality up to 29%
  • Echo identified right heart thrombus most likely requires more aggressive treatment such as embolectomy or lytic therapy compared to heparin alone, however this requires further investigation"