HWN Suggests

Managing Acute Right Ventricular Failure

In critically patients with decompensated RV failure who have not responded to other therapies, inhaled nitric oxide should be considered. Nitric oxide selectively dilates the pulmonary vasculature – both decreasing pulmonary vascular resistance and improving ventilation perfusion matching by increasing perfusion to well ventilated parts of the lung.17 Inhaled prostacyclins such as epoprostanol or iliprost similarly dilate the pulmonary vasculature, but, unlike nitric oxide, can have systemic effects and should not be initiated without involvement of specialty services.

read full article

Featured

 Acute Right Ventricular Failure in the ED

Let’s be honest, patients with right ventricular (RV) failure terrify us as emergency medicine (EM) physicians, particularly when they are acutely decompensating. There are limited therapeutic options, they are brittle in their response to interventions, and they are usually on a spectrum of vasodilators that we have to reference on Up-To-Date.

Articles of Interest

Demystifying Right Heart Ultrasound via Melissa Myers, MD

In this 15-minute video from day 2 of the Rebellion in EM 2021 conference, Dr. Melissa Myers, MD helps you take your echo to the next level by demystifying right heart ultrasound. In this lecture she teaches how to evaluate right heart strain

Pulmonary hypertension and right ventricular failure

Both the underlying pathophysiology and the management of pulmonary hypertension and right ventricular failure are incredibly complex.

Right Heart Strain on EKG

EKG is neither sensitive nor specific for PE, but there are some clues that can be another data point in your decision making. Remember, EKG stands for electrocardiogram, not pulmonary-artery-gram. The absence of these findings should not decrease your suspicion of PE.

Right Ventricular Failure

Find and treat the cause (e.g. PE, ARDS, MV failure, fluid overload, pulmonary HTN). Management focuses on: volume and preload optimisation / RV contractility / RV afterload reduction.

Right Ventricular failure due to pulmonary hypertension

The right ventricle is truly the forgotten ventricle. Most textbooks on critical care cardiology are written almost entirely about left ventricular failure. Likewise, nearly all evidence surrounding heart failure is with regards to the left ventricle. There is nearly no high-quality evidence regarding the management of right ventricular failure