RV failure

Talal Dahhan, MD, MSEd.

 

Please take a look at the presentation for a short review on acute right sided heart failure, evaluation and management.

 

Acute Right Sided Heart Failure Management video

 

Points to remember:

 

  • Patients who present with shock, might have right sided heart failure.
  • Try to:
    • Carefully evaluate history.
    • Look for signs of right sided heart failure, such as; distended JVP, Congested Liver, Ascites and LL edema.
  • Laboratory assessment:
    • Cardiac biomarkers: NT-ProBNP, CK-MB and Troponin T trendings might be helpful.
    • Liver enzymes.
    • Kidney function and urine output follow up.
  • Echocardiography
  • Radiographic images: CT scans might be helpful.
  • Right heart catheterization.
  • Management:
    • Be sure of volume status, careful assessment and follow up of that!
    • Inotropes to consider:
      • Dobutamine
      • Milrinone
      • Norepinephrine
      • Vasopressin
      • Dopamine (<10 mcg/Kg/min).
    • Inotropes to avoid:
      • Higher doses of Dopamine (>10 mcg/kg/min).
      • Phenylephrine
    • Pulmonary Vasodilator therapies to consider:
      • inhaled nitric oxide (super expensive)
      • Nebulized iloprost: 10 mcg nebulized q3H.
      • Intravenous prostanoids: Epoprostenol or Treprostinil.

 

References:

  • Haddad F et al, 2008;117:1717-31.
  • Wilcox et al, Ann Em Med, 2015 Dec;66(6):619-28.
  • Voelkel et al, Circulation, 2006 Oct 24;114(17):1883-91.
  • Lahm et al, JACC, 2010 Oct 26;56(18):1435-46.