Right heart failure

Abstract

Right ventricular failure (RVF) is a frequent and formidable clinical challenge in the intensive care unit, the operating room, the general ward, and the outpatient setting. The presence of RVF (1) carries substantial morbidity and mortality and (2) complicates the use of commonly employed treatment strategies in both inpatients and outpatients. In contrast to the left ventricle (LV), the right ventricle (RV) remains relatively understudied, and none of the major professional societies have published any guidelines on how to approach patients with RVF. Due to embryological, anatomical, physiological, biochemical, and electrophysiological differences between the RV and LV, paradigms that are important for the treatment of the failing LV cannot be extrapolated to RVF. However, with pulmonary hypertension (PH) having become a major area of scientific and clinical interest, recent studies have shed more light on the physiology of the normal RV and the pathophysiology of its failure. Using a comprehensive and evidence-based approach, this chapter will (1) highlight the pathophysiology of the failing RV; (2) discuss the etiologies of acute, chronic, and acute-on-chronic RVF; (3) describe invasive and noninvasive approaches that assist in diagnosis and risk stratification; and (4) emphasize treatment strategies for stable (chronic) and decompensated (acute) RVF.