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Semin Respir Crit Care Med 2015; 36(06): 934-942
DOI: 10.1055/s-0035-1564925
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Assessment of the Right Heart Failure Syndrome

Cyrus A. Kholdani
1   Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, California
,
Ronald J. Oudiz
2   Division of Cardiology, Liu Center for Pulmonary Hypertension, LA Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, California
,
Wassim H. Fares
3   Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
› Author Affiliations
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Publication History

Publication Date:
23 November 2015 (online)

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Abstract

The right heart failure (RHF) syndrome is a pathophysiologically complex state commonly associated with dysfunction of the right ventricle (RV). The normal RV is suited for its purposes of distributing venous blood to the low-resistance pulmonary circulation. Myriad stresses imposed upon it, though, can ultimately result in its failure, with the threat of cardiovascular collapse being the most dreaded outcome. Decreased cardiac output with increased central venous pressures are hemodynamic hallmarks of this highly morbid condition. Proper management of RHF is predicated on the accurate assessment of the key hemodynamic and clinical components signaling the syndrome that is the result of the failing RV. Appropriate use of diagnostic tools is paramount for understanding the key components of RV function: the preload state of the RV, its contractility, and the afterload burden placed on it. In making these assessments, it remains crucial to understand the limitations of these tools when managing RHF in the intensive care unit. An understanding of each of these components allows for the understanding of the physiology and the clinical presentation which can guide the use of therapies appropriately tailored to manage the condition.

Keywords

right heart failure - right ventricular failure - pulmonary arterial hypertension - pulmonary hypertension - right ventricle
 

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