Bernheim effect
Bernheim effect
The Bernheim effect is a clinical sign related to left ventricular compression by the right ventricle in certain cardiac conditions.
Definition
- The Bernheim effect occurs when right ventricular hypertrophy or dilation pushes the interventricular septum into the left ventricle, reducing its filling capacity.
- This can lead to reduced left ventricular stroke volume, even without left-sided heart disease.
Mechanism
- Right ventricular pressure rises (commonly due to pulmonary hypertension or right ventricular hypertrophy).
- The interventricular septum bows toward the left ventricular cavity during diastole.
- Left ventricular end-diastolic volume decreases → reduced cardiac output.
- The Bernheim sign refers to this septal displacement seen on imaging or at autopsy.
Causes
- Severe pulmonary hypertension
- Congenital heart disease (e.g., Tetralogy of Fallot, Eisenmenger syndrome)
- Advanced cor pulmonale
- Occasionally in right ventricular infarction
Clinical Clues
- Symptoms of low cardiac output despite normal LV systolic function on echocardiography.
- Right-sided heart failure signs predominate.
- Echo or MRI: septal bulging into LV in diastole.
Key Point
- It’s more of a pathophysiological concept than a standalone diagnosis.
- Modern imaging has shown that the Bernheim effect is rare and usually part of broader ventricular interdependence physiology.
1. The Bernheim effect is primarily related to:
The Bernheim effect describes mechanical encroachment of an enlarged left ventricle into the right ventricular cavity, reducing its filling.
2. Which part of the heart is directly compressed in the Bernheim effect?
In the Bernheim effect, the interventricular septum bulges into the right ventricle during diastole, reducing right ventricular cavity size.
3. The Bernheim effect was first described in:
Hippolyte Bernheim described the effect in the early 20th century, focusing on LV hypertrophy causing RV compression.
4. Which condition is most likely to precipitate a Bernheim effect?
Severe LV hypertrophy can cause septal shift toward the RV, leading to the Bernheim effect.
5. The Bernheim effect may mimic signs of:
Reduced RV filling can cause peripheral edema, elevated JVP, and other signs resembling right heart failure.
6. Which diagnostic modality best detects the Bernheim effect?
Echocardiography can directly visualize septal displacement into the RV and LV hypertrophy.
7. The interventricular septal shift in the Bernheim effect occurs during:
During diastole, LV hypertrophy causes the septum to bulge into the RV cavity, reducing its diastolic filling.
8. The Bernheim effect is most often a result of:
Chronic hypertension or aortic stenosis can cause LV hypertrophy, the primary substrate for the Bernheim effect.
9. Which symptom is NOT typically due to the Bernheim effect?
Pulmonary edema is more related to left-sided heart failure; Bernheim effect predominantly mimics right-sided symptoms.
10. Treatment of Bernheim effect focuses on:
Addressing the underlying cause of LV hypertrophy (e.g., hypertension, aortic stenosis) alleviates the Bernheim effect.
11. The Bernheim effect primarily refers to:
The Bernheim effect occurs when LV hypertrophy pushes the interventricular septum into the RV cavity, reducing RV filling.
12. In the Bernheim effect, which phase of the cardiac cycle is most affected for RV filling?
RV filling is impaired during diastole due to septal displacement from LV hypertrophy.
13. Which echocardiographic feature supports the diagnosis of the Bernheim effect?
Echocardiography shows diastolic septal bulge toward the RV cavity, indicating compression from LV hypertrophy.
14. The Bernheim effect can mimic which right-sided condition clinically?
The Bernheim effect reduces RV output, producing signs of right heart failure despite a normal pulmonary valve.
15. Which cardiac chamber is structurally normal in the Bernheim effect despite functional compromise?
The RV is structurally normal but functionally restricted by septal bulging from LV hypertrophy.
16. Which condition is most commonly associated with the Bernheim effect?
Systemic hypertension often leads to LV hypertrophy, which predisposes to the Bernheim effect.
17. The Bernheim effect was first described in which year?
The Bernheim effect was described in 1910 by Hippolyte Bernheim.
18. Cardiac MRI in the Bernheim effect would most likely show:
MRI reveals septal shift toward RV due to LV hypertrophy, confirming mechanical compression.
19. Which invasive hemodynamic finding supports the Bernheim effect diagnosis?
RV diastolic pressure is elevated due to impaired filling, but pulmonary pressures remain normal.
20. Treatment of Bernheim effect primarily focuses on:
Reducing LV hypertrophy (e.g., controlling hypertension) alleviates septal bulging and RV compression.
| Q.No | Question | Answer |
|---|---|---|
| 1 | What is the Bernheim effect? | Right ventricular compression by the interventricular septum due to left ventricular enlargement. |
| 2 | Which side of the heart is primarily enlarged in Bernheim effect? | Left ventricle. |
| 3 | Which cardiac structure shifts in Bernheim effect? | Interventricular septum. |
| 4 | Main physiological consequence of Bernheim effect? | Right ventricular inflow obstruction. |
| 5 | Which heart sound abnormality may be heard? | Loud S2 due to pulmonary hypertension. |
| 6 | Bernheim effect is often confused with? | Primary right ventricular outflow obstruction. |
| 7 | Is Bernheim effect a primary right heart disease? | No, it is secondary to left ventricular pathology. |
| 8 | Common ECG finding? | Left ventricular hypertrophy pattern. |
| 9 | Preferred imaging modality? | Echocardiography. |
| 10 | Role of cardiac MRI? | Accurate visualization of septal displacement and chamber volumes. |
| 11 | Hemodynamic hallmark? | Reduced right ventricular end-diastolic volume despite normal pulmonary pressures. |
| 12 | Main differential diagnosis? | Primary pulmonary hypertension. |
| 13 | Common cause of LV hypertrophy leading to Bernheim effect? | Long-standing systemic hypertension. |
| 14 | Can Bernheim effect occur in hypertrophic cardiomyopathy? | Yes, especially with asymmetric septal hypertrophy. |
| 15 | Right ventricular failure signs in Bernheim effect are due to? | Mechanical obstruction of RV inflow, not intrinsic RV weakness. |
| 16 | Effect on jugular venous pulse? | Elevated JVP with prominent a wave. |
| 17 | Definitive treatment? | Treat underlying LV hypertrophy or structural cause. |
| 18 | Medical management focus? | Afterload reduction and control of hypertension. |
| 19 | Surgical consideration? | Septal myectomy in severe obstructive cases. |
| 20 | Prognosis depends on? | Severity of LV disease and response to treatment. |
Bernheim effect
| Q | A |
|---|---|
| What is the Bernheim effect? | Right ventricular inflow obstruction caused by left ventricular enlargement and septal shift. |
| Which ventricle is primarily enlarged? | Left ventricle. |
| Which structure shifts in Bernheim effect? | Interventricular septum. |
| Main physiological effect? | Reduced right ventricular filling. |
| Is it a primary right heart disease? | No, secondary to LV disease. |
| Key ECG feature? | LV hypertrophy pattern. |
| Main imaging tool? | Echocardiography. |
| Role of MRI? | Detailed chamber and septal assessment. |
| Hemodynamic hallmark? | Small RV end-diastolic volume with normal pulmonary pressures. |
| Common cause? | Long-standing hypertension. |
| Occurs in HCM? | Yes, with septal hypertrophy. |
| Right heart signs due to? | Mechanical inflow obstruction. |
| Effect on JVP? | Elevated with prominent a wave. |
| Treatment focus? | Address underlying LV problem. |
| Medical approach? | Afterload reduction. |
| Surgical option? | Septal myectomy if severe. |
| Prognosis depends on? | LV disease severity. |
| Often confused with? | Primary pulmonary hypertension. |
| Heart sound change? | Loud S2. |
| ECG clue? | High voltage QRS from LVH. |
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