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.