Right Ventricular Dysfunction Secondary to Myocardial Ischemia Provoked by Stress Testing

Area of Science:

• Cardiology
• Diagnostic Imaging

Background:

• Chest pain is a common symptom requiring diagnostic evaluation.
• Stress echocardiography is frequently used to assess for myocardial ischemia.
• Right ventricular ischemia is less commonly recognized than left ventricular ischemia.

Purpose of the Study:

• To report two cases of significant right ventricular dysfunction during stress echocardiography.
• To investigate the role of proximal right coronary artery stenosis in these findings.
• To emphasize the importance of evaluating right ventricular function in stress tests.

Main Methods:

• Two patients with chest pain underwent stress echocardiography.
• Echocardiographic parameters, including right ventricular size and function, were monitored.
• Right coronary artery stenosis was assessed, and angioplasty was performed in both cases.
• Repeat stress testing was conducted post-intervention.

Main Results:

• Both patients exhibited severe right ventricular enlargement and hypokinesis at low exercise levels.
• One patient experienced hemodynamic collapse with bradycardia and hypotension; the other had hypoperfusion symptoms.
• Angioplasty of critical proximal right coronary artery stenosis led to complete resolution of right ventricular dysfunction.
• Repeat stress testing showed normalization of right ventricular function.

Conclusions:

• Stress-induced myocardial ischemia can predominantly affect the right ventricle.
• Right ventricular dysfunction during stress testing may be caused by critical right coronary artery stenosis.
• Routine assessment of right ventricular function should be incorporated into stress echocardiography protocols.