Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association

Abstract

RHF is a complex syndrome including diverse causes, pathways, and pathological processes. In this scientific statement, we review the causes and epidemiology of RV dysfunction and the pathophysiology of acute and chronic RHF and provide guidance for the management of the associated conditions leading to and caused by RHF.

SCAI clinical expert consensus statement on the classification of cardiogenic shock

“…Pulmonary artery (PA) catheters can directly measure right atrial (RA), PA and pulmonary capillary wedge pressures (PCWP), mixed venous oxygenation, cardiac output (CO) and allows calculation of CI, systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), pulmonary artery pulsatility index (PAPI), and cardiac power output (CPO). Recent reviews of the hemodynamics of CS provide further details on the derived values and interpretation of these indices in this setting …”

“…setting. 36,37 Although hemodynamic definitions of CS may vary, the National Cardiovascular Data Registry defines CS as systolic blood pressure ≤ 90 and cardiac index <2.2 L/min/m 2 and/or the requirement for parenteral inotropic or vasopressor agents or mechanical support to maintain BP and CI above these levels. 38 Although classic "cold, wet" CS is associated with low CI and high SVR and PCWP, there are four different common hemodynamic types of CS which are difficult to determine without invasive hemodynamic monitoring, and importantly, the patient may go from one category to another (Figure 2).…”

Management of Heart Failure in Adult Congenital Heart Disease

“…Given the heterogenous nature of CHD and palliative or surgical repair, the cause and presentation of HF in CHD is diverse. Some common themes in describing HF in this population include the side of the HF (subpulmonic ventricular vs subsystemic ventricular dysfunction), 21 cyanotic versus acyanotic HF, single ventricular failure, and pressure versus volume-mediated HF, among others.…”

Opportunities for training to advance the care for adults with congenital heart disease with advanced circulatory failure

“…[8][9][10][11] Single ventricle patients palliated to Fontan circulation can develop end-stage multi-organ dysfunction including hepatopathy, cyanosis, or hyperammonemia resulting from the development of veno-venous collaterals, circulatory inefficiency from a heavy aortopulmonary collateral burden, poorly understood chronic renal disease, development of micro-arteriovenous malformations in the pulmonary circulation from inadequate delivery of hepatic factor, protein losing enteropathy, plastic bronchitis, incessant arrhythmias, and systolic and/or diastolic heart failure. Symptomatology differs by disease processes including pulmonary hypertension/Eisenmenger's syndrome and chronic cyanosis; systemic right ventricular failure after an atrial switch operation or physiologically palliated congenitally corrected transposition of the great arteries; and left, right, or biventricular failure from unusual mechanisms in the tetralogy of Fallot population.…”

“…Symptomatology differs by disease processes including pulmonary hypertension/Eisenmenger's syndrome and chronic cyanosis; systemic right ventricular failure after an atrial switch operation or physiologically palliated congenitally corrected transposition of the great arteries; and left, right, or biventricular failure from unusual mechanisms in the tetralogy of Fallot population. [8][9][10][11] Single ventricle patients palliated to Fontan circulation can develop end-stage multi-organ dysfunction including hepatopathy, cyanosis, or hyperammonemia resulting from the development of veno-venous collaterals, circulatory inefficiency from a heavy aortopulmonary collateral burden, poorly understood chronic renal disease, development of micro-arteriovenous malformations in the pulmonary circulation from inadequate delivery of hepatic factor, protein losing enteropathy, plastic bronchitis, incessant arrhythmias, and systolic and/or diastolic heart failure. [12][13][14][15] Traditional means of treating heart failure may not be applicable in these populations.…”