Critical Care Management of Decompensated Right Heart Failure in Pulmonary Arterial Hypertension Patients – An Ongoing Approach

Ţilea, Ioan; Varga, Andreea; Georgescu, Anca-Meda; Grigorescu, Bianca Liana

doi:10.2478/jccm-2021-0020

Cited by 5 publications

(11 citation statements)

References 97 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The rapid onset (15 minutes), peak effects (60 minutes) and a 4-6 hour onset of action of Sildenafil increase of cardiac output and RV contractility, decrease of mPAP and PVR. [27][28][29] Sildenafil recommendations according to WHO functional class II-III is IA. 30 Diuretics are used in volume management in patients with PAH is the several classes.…”

Section: Discussionmentioning

confidence: 99%

A 28-Year-Old Male Patient With Right Heart Failure Due To Pulmonary Hypertension

Savitri¹,

Siregar

Septina

et al. 2022

DMJ

View full text Add to dashboard Cite

Right Heart Failure (RHF) as a rapidly progressive syndrome with systemic congestion in the setting of impaired RV filling and/or decreased RV outflow output. A 28-year-old male patient, a photographer, lived in North Aceh was admitted to the ED of Cut Meutia Hospital. He was admitted with worsening dyspnea since 2 days before, initiated after a periode of fever. He also complained of fatigue, palpitations in ordinary activities and chest pain occasionally. He had history of presyncope and syncope. He denied any history of hypertension, type 2 diabetes, allergies, and active smoking. He had no congenital or family history of heart disease. Physical examination revealed full of conciousness with slightly abnormal vital sign. He had malar rash, dilated jugular vein. The apex of the heart shifts to the axilla anterior line, S1>S2 with systolic murmur (+). ECG showed complete RBBB with RAD and chest x-ray showed cardiomegaly. The transthoracic echocardiogram revealed severe TR (Tricuspid Regurgitation), dilatation of RARV (Right Atrium Right Ventricle), with severe PH (Pulmonary Hypertension). The patient was diagnosed with RHF (Right Heart Failure) caused by primary PH. The patient was placed on intravenous furosemide, spironolacton, digoxin, and sildenafil. Treatment and lifestyle modification were expected to improve the quality of life.

show abstract

Section: Discussionmentioning

confidence: 99%

A 28-Year-Old Male Patient With Right Heart Failure Due To Pulmonary Hypertension

Savitri¹,

Siregar

Septina

et al. 2022

DMJ

View full text Add to dashboard Cite

show abstract

“…PACs may be useful adjuncts to guide fluid management and titrate vasoactive medications in selective high-risk patients when significant hemodynamic disturbances are expected; however, their utility has been debated (Wanner and Filipovic 2020 ). Monitoring trends in CVP, pulmonary artery pressure (PAP), CO, and mixed venous oxygen saturation (SvO 2 ) can provide useful feedback, but interpretation requires a thorough understanding (Tilea et al 2021 ; Marik 2013 ).…”

Section: Methodsmentioning

confidence: 99%

Perioperative management of the vulnerable and failing right ventricle

Arora,

Brown,

Chatterjee

et al. 2024

Perioper Med

View full text Add to dashboard Cite

Under recognition combined with suboptimal management of right ventricular (RV) dysfunction and failure is associated with significant perioperative morbidity and mortality. The contemporary perioperative team must be prepared with an approach for early recognition and prompt treatment. In this review, a consensus-proposed scoring system is described to provide a pragmatic approach for expeditious decision-making for these complex patients with a vulnerable RV. Importantly, this proposed scoring system incorporates the context of the planned surgical intervention. Further, as the operating room (OR) represents a unique environment where patients are susceptible to numerous insults, a practical approach to anesthetic management and monitoring both in the OR and in the intensive care unit is detailed. Lastly, an escalating approach to the management of RV failure and options for mechanical circulatory support is provided.

show abstract

“…Bradyarrhythmias and ventricular arrhythmias are rare in patients with RV failure, except in cases of cardiac arrest [4]. The development of SVT is considered a negative prognostic marker in ARHF and is associated with right ventricular failure and increased mortality [37]. Patients with atrial tachyarrhythmias may benefit from electrical cardioversion, as the dysrhythmia can lead to worsening right ventricular cardiac output due to the loss of atrial kick [17], although large-scale studies on its use have yet to be studied in RV failure [4].…”

Section: Anti-arrhythmicsmentioning

confidence: 99%

“…Patients with atrial tachyarrhythmias may benefit from electrical cardioversion, as the dysrhythmia can lead to worsening right ventricular cardiac output due to the loss of atrial kick [17], although large-scale studies on its use have yet to be studied in RV failure [4]. Amiodarone and digoxin are the leading choices for the restoration of sinus rhythm [34,37]. Radiofrequency ablation is another option for patients with recurrent SVT [1].…”

Section: Anti-arrhythmicsmentioning

confidence: 99%

Approach to Decompensated Right Heart Failure in the Acute Setting

Levitt,

Williams,

Ahari

et al. 2024

JCM

View full text Add to dashboard Cite

Acute right heart failure (ARHF) arises when the right ventricle fails to pump blood efficiently to the pulmonary circulation. This inefficiency leads to a decreased blood supply to various organs. ARHF is a significant health concern, often leading to increased hospital admissions and being associated with a higher risk of mortality. This condition underscores the importance of effective cardiac care and timely intervention to manage its complications and improve patient outcomes. Diagnosing ARHF involves a comprehensive approach that includes a physical examination to evaluate the patient’s fluid status and heart-lung function, blood tests to identify potential triggers and help forecast patient outcomes and various imaging techniques. These imaging techniques include electrocardiograms, point-of-care ultrasounds, computed tomography, cardiac magnetic resonance imaging, and other advanced monitoring methods. These diagnostic tools collectively aid in a detailed assessment of the patient’s cardiac and pulmonary health, essential for effective management of ARHF. The management of ARHF focuses on addressing the underlying causes, regulating fluid balance, and enhancing cardiac function through pharmacological treatments or mechanical support aimed at boosting right heart performance. This management strategy includes the use of medications that modulate preload, afterload, and inotropy; vasopressors; anti-arrhythmic drugs; ensuring proper oxygenation and ventilation; and the utilization of heart and lung assist devices as a bridge to potential transplantation. This review article is dedicated to exploring the pathophysiology of ARHF, examining its associated morbidity and mortality, evaluating the various diagnostic tools available, and discussing the diverse treatment modalities. The article seeks to provide a comprehensive understanding of ARHF, its impact on health, and the current strategies for its management.

show abstract

Critical Care Management of Decompensated Right Heart Failure in Pulmonary Arterial Hypertension Patients – An Ongoing Approach

Cited by 5 publications

References 97 publications

A 28-Year-Old Male Patient With Right Heart Failure Due To Pulmonary Hypertension

A 28-Year-Old Male Patient With Right Heart Failure Due To Pulmonary Hypertension

Perioperative management of the vulnerable and failing right ventricle

Approach to Decompensated Right Heart Failure in the Acute Setting

Contact Info

Product

Resources

About