Assessment of right heart function

Growing recognition of the contribution of right heart function to cardiac output in a variety of pathologic conditions lends a new outlook to cardiac assessment, especially when cardiac output is inadequate for physiologic needs. Signs and symptoms of right heart dysfunction made by physical assessment can be validated by radiologic techniques as well as a newly available bedside method of thermodilution determination of right ventricular ejection fraction and right ventricular end-diastolic and end-systolic volumes. Assessment of right ventricular function can aid clinical decision making when pressure readings obtained by usual hemodynamic monitoring techniques are altered by changes in intrathoracic pressure or ventricular compliance. This article reviews physical assessment of right heart function, signs and symptoms of right heart dysfunction, radiographic evaluations and their limitations and introduces the thermodilution evaluation of right ventricular performance. Clinical examples are presented to illustrate the utility of this new technique along with selected nursing diagnoses and outcome criteria.