Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology

Abstract

Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses 227to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a cascade leading to increasing venous congestion. Ventricular interdependence results in impaired left ventricular filling, a decrease in left ventricular stroke volume, and ultimately low cardiac output and cardiogenic shock. Identification and treatment of the underlying cause of RV failure, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmia, is the primary management strategy. Judicious fluid management, use of inotropes and vasopressors, assist devices, and a strategy focusing on RV protection for mechanical ventilation if required all play a role in the clinical care of these patients. Future research should aim to address the remaining areas of uncertainty which result from the complexity of RV haemodynamics and lack of conclusive evidence regarding RV-specific treatment approaches.

Optimal right heart filling pressure in acute respiratory distress syndrome determined by strain echocardiography

“…4,5 This has resulted in five general management principles: (1) optimize RV preload, (2) optimize RV systolic function, (3) reduce RV afterload, (4) maintain an appropriate systemic blood pressure, and (5) treat the underlying disease. While preload optimization is crucial in its management, dynamic fluid responsiveness indices lack reliability, and there is no consensus on target central venous pressure (CVP).…”

The Right Ventricle: From Bench to Bedside

“…It can be due to either acute pressure or volume overload or other aggravating factors leading to a reduction of myocardial contractility owing to ischemia, cardiomyopathy, or arrhythmia [10]. J. C. Grignola and E. Domingo discuss in their paper from the present issue the mechanisms and management of acute RV dysfunction in the intensive care unit.…”

İleri evre kalp yetersizliği rehberi

“…Deneysel modellerde bu adaptasyon 2 tipte olabilir: Adapatif veya maldaptif. [143,144] Erken dönemde sağV ile pulmoner arter arasındaki eşleşmeyi (coupling) sağlamak için 'homeometrik adaptasyon' ile sabit koroner perfüzyonda sağV dilate olmadan mükem-mel bir adaptasyon ile kontraksiyon kabiliyetini 5 kat artırabilir. [143] SağV konsantrik hipertrofinin (artmış kitle/hacim oranı) belirgin olduğu 'adaptif yeniden şekillenme'de sistolik ve diyastolik fonksiyonlar korunmuştur.…”