How to assess the right ventricle in COVID-19 patients using echocardiography

COVID-19 patients are at higher risk of developing a pulmonary embolism, so right ventricular systolic function and inferior vena cava dilatation are key features to assess in these patients. In this video, from our COVID Mini: Handheld Echocardiography course, we'll look at how to assess the right ventricle using a handheld echo device, as well as the important signs to look for in COVID-19 patients who are at risk of developing a pulmonary embolism.

COVID-19 has changed the delivery of inpatient echocardiography in order to prevent cross-infection with healthcare professionals. This course will teach you how to use point-of-care cardiac ultrasound to rapidly assess the hemodynamic effects of SARS-CoV-2 on patients, while limiting the risk to yourself. Learn how to use these findings to guide your management of the ensuing COVID-19 clinical syndrome.

In this Medmastery lesson, we will learn how to assess the right ventricle using handheld echocardiography. During the course of the COVID-19 clinical syndrome, disseminated micro-thromboembolic phenomenon has been described. When these occur in the pulmonary vasculature, these clots can result in pulmonary embolism.

Focus right ventricular assessment of a patient with COVID-19 will typically demonstrate right ventricular dilatation and signs of right ventricular strain. This results from an increase right ventricular afterload and increased pulmonary vascular resistance. Acute pressure overload states due to pulmonary emboli are poorly tolerated by the right ventricle.

Right ventricular systolic function together with characteristic interventricular septal motion, and inferior vena cava dilatation are key features to assess in a patient with COVID-19. Increased right ventricular pressure overload can be qualitatively assessed by the motion of the interventricular septum, which may exhibit the paradoxical septal motion.

As a consequence of pressure overload, since the interventricular septum is a shared structure, the left ventricle may show signs of underfilling as the heart contracts in a confined space. This reduced left ventricular filling may result in the left atrium and left ventricle chambers appearing smaller. Conversely, due to the increased right ventricular afterload, right atrial pressures increase, with resulting tricuspid regurgitation and a dilated, non-collapsing inferior vena cava.