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Right or left, which one to bet?

“To be, or not to be, that’s the question!”

Shakespeare’s Hamlet.

Recently I was amazed that in our extremely sophisticated and advanced medical world cardiologists are unable for a long period of time to distinguish between a problem of the left heart and the right one.

Being myself a radiologist I was completely frustrated because I had in fact all elements in my hand.

In reality this should be an easy question even for a GP.

Lung emboli provoke a typical picture on echocardiography, which is called heart apex dyskinesias.

Every physician should know it!

When chronic, this entity causes pulmonary arterial hypertension.

The result is hypertrophy of right ventricle, but when lasting for years, also oof left one.

Here why:

Induced slight acceleration of heart rate, which becomes constant, puts more strain on left heart.

As a matter of fact, if you observe hypertrophy of both ventricles, the next question to ask yourself is whether the mitral valve is competent.

If that’s the case, check pulse rate on the long run!

Hypertension of peripheral arteries slows down this one, while of the pulmonary one, there is acceleration.

The only problem is that if observation is not as big as the Empire State Building, it is considered irrelevant by most colleagues.

Hence, bouts of sinus tachycardia, or even slight acceleration of pulse below 90/minute, should prompt investigation for recurrent lung emboli.