- Failure occurs when the RV fails to maintain enough perfusion through pulmonary circulation to achieve adequate left ventricular filling
- This occur suddenly in a previously healthy heart (massive PE, right sided MI) or worsening of compensated RV failure in setting of chronic heart/lung disease
- When RVEDP > LVEDP, septum flattens and āDā shape is seen on cross section of ultrasound
- Management:
- Reverse the underlying cause and any condition that increase pulmonary vascular tone
- Optimize right sided filling pressures and reduce after-load (i.e., elevated pulmonary pressures)
- Use selective pulmonary vasodilators at doses that do not induce systemic hypotension and worsening of oxygenation
- Use inotropic agents to help improve RV contractility enough to maintain cardiac output
- Consider ECMO if all else fails while underlying cause of RV failure is being addressed
References