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Right heart failure - Coggle Diagram
Right heart failure
Importance
As common as isolated LV failure
Worse prognosis
Poorly managed
Causes
Normal afterload
RV infarction
Cardiomyopathy
Increased afterload
PE
Pulmonary HTN
mitral valve disease
COPD
OSA
Increased pulmonary vasculare resitance
hypoxia
hypercapnnia
Acidosis
Volume overload
LV failure
Left to right shint
ASD VSD
Features
Pulmonary HTN
Loaud P2
Split S2
Tricuspid regirgitation
RV hypertrophy
Prominent a wave
Fourth HS
Heave
RV dilation
Increased JVP
v wave
third HS
Oedmea
Ascites
Pulsatile hepatomegaly
Definition
RVSP >25
TAPSE <16
Management
Principles
Preload
INcrease if acute
Decrease if chronic
Afterload
prevent vasoconstriction
pulmonary vasodilation
nitric
prostaglandin
sildenafil
Contractility
dobutamine
Milranone
Specific
Investigate
PA cath
TOE
Reduce PVR
oxygen
pH
C02
Improve RV function
minimal PEEP
Ensure right coronary perfusion
DBP>RVEDP
Mechnical
ECMO
VAD
Biventricular pacing
Pathophysiology
Rise in PVR
Increase in RVEDP
Dilation of RV and loss of crecentric shape
interventricular septum bulges
Ventricular interdependence
Reduction in coronary perfusion