How to Treat Right Heart Failure. Tips for Clinicians in Everyday Practice

Crisci, Giulia; D’Assante, Roberta; Valente, Valeria; Giardino, Federica; D’Agostino, Anna; Ranieri, Brigida; Arcopinto, Michele; Marra, Alberto M.; Rainone, Carmen; Modestino, Michele; Rega, Salvatore; Fulgione, Ludovica; Sepe, Chiara; Caruso, Giuseppe; Bossone, Eduardo; Salzano, Andrea; Cittadini, Antonio

doi:10.1016/j.hfc.2022.08.022

Cited by 2 publications

(9 citation statements)

References 61 publications

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“…In PAH and PE, there may also be evidence of intraventricular septal flattening on this view with a D-shaped LV [4]. Additionally, a plethora of inferior vena cava (diameter < 10 mm) without inspiratory collapse, reduced fractional area change (<35%), and a left shift of the septum with paradoxical movement can also be seen on bedside echo in patients with right heart failure [2,8,9,12]. Fractional area change (FAC) provides an estimate of the right ventricular systolic function [13].…”

Section: Diagnosis and Evaluationmentioning

confidence: 96%

“…It is known that all causes of left-heart failure will eventually lead to right-heart failure [9]. This is because the right ventricle contains a relatively thin wall (compared to the left ventricle) that is designed to pump into the pulmonary circulation, which normally has low resistance, high compliance, and low impedance [1,[10][11][12]. The thin wall of the RV is more dependent on coronary perfusion pressure and is greatly impacted by increases in RV pressure, as well as systemic hypoperfusion [5].…”

Section: Physiology and Pathophysiologymentioning

confidence: 99%

“…In the emergent setting, it may be difficult to clinically distinguish between acute right or left heart failure; therefore, a detailed history and physical exam and a high level of suspicion can help guide providers. Findings suggestive of ARHF may include dyspnea, anxiety, early satiety, tachycardia, tachypnea, hypoxemia, peripheral edema, relative hypotension, cool/clammy skin, abdominal fullness, or right upper quadrant tenderness [2][3][4]8,9,12]. Physicians should look for evidence of elevated jugular venous pressure, ascites, or hepatojugular reflux, and heart sounds such as tricuspid regurgitation, a loud pulmonary component of the second heart sound (S2), fixed splitting of the S2, or a RV heave [2,4,8,9].…”

Section: Diagnosis and Evaluationmentioning

confidence: 99%

“…Anemia, even isolated iron-deficiency anemia, has been suggested to worsen RV function, and recommendations include maintaining hemoglobin levels greater than 10 g/dL [10]. An electrocardiogram (EKG) with evidence of right heart pathology such as right atrial dilation, rightward axis deviation, right ventricular hypertrophy, right bundle branch block, or arrhythmogenic right ventricular cardiomyopathy (ARVC) may suggest the diagnosis of ARHF [2,4,8,9,12]. Dysrhythmias may also be noted on the EKG due to rises in right atrial pressures [17].…”

Section: Diagnosis and Evaluationmentioning

confidence: 99%

“…All echocardiographic views can help provide the clinician with information on diagnosis and can be used to identify extrinsic causes of acute RV failure, such as pericardial tamponade, a common mimic of ARHF [3]. The apical 4 chamber view can demonstrate right ventricular dilation and enlargement compared to the left ventricle, and when using M-mode aligned with the tricuspid annulus, measurement of the tricuspid annular plane systolic excursion (TAPSE) can be obtained [1][2][3]8,9,12]. TAPSE is a marker of right ventricular systolic function, and when decreased to less than 1.7 cm, it can be associated with ARHF [2,8,9].…”

Section: Diagnosis and Evaluationmentioning

confidence: 99%

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Approach to Decompensated Right Heart Failure in the Acute Setting

Levitt,

Williams,

Ahari

et al. 2024

JCM

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Acute right heart failure (ARHF) arises when the right ventricle fails to pump blood efficiently to the pulmonary circulation. This inefficiency leads to a decreased blood supply to various organs. ARHF is a significant health concern, often leading to increased hospital admissions and being associated with a higher risk of mortality. This condition underscores the importance of effective cardiac care and timely intervention to manage its complications and improve patient outcomes. Diagnosing ARHF involves a comprehensive approach that includes a physical examination to evaluate the patient’s fluid status and heart-lung function, blood tests to identify potential triggers and help forecast patient outcomes and various imaging techniques. These imaging techniques include electrocardiograms, point-of-care ultrasounds, computed tomography, cardiac magnetic resonance imaging, and other advanced monitoring methods. These diagnostic tools collectively aid in a detailed assessment of the patient’s cardiac and pulmonary health, essential for effective management of ARHF. The management of ARHF focuses on addressing the underlying causes, regulating fluid balance, and enhancing cardiac function through pharmacological treatments or mechanical support aimed at boosting right heart performance. This management strategy includes the use of medications that modulate preload, afterload, and inotropy; vasopressors; anti-arrhythmic drugs; ensuring proper oxygenation and ventilation; and the utilization of heart and lung assist devices as a bridge to potential transplantation. This review article is dedicated to exploring the pathophysiology of ARHF, examining its associated morbidity and mortality, evaluating the various diagnostic tools available, and discussing the diverse treatment modalities. The article seeks to provide a comprehensive understanding of ARHF, its impact on health, and the current strategies for its management.

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Section: Diagnosis and Evaluationmentioning

confidence: 96%

Section: Physiology and Pathophysiologymentioning

confidence: 99%

Section: Diagnosis and Evaluationmentioning

confidence: 99%

Section: Diagnosis and Evaluationmentioning

confidence: 99%

Section: Diagnosis and Evaluationmentioning

confidence: 99%

See 3 more Smart Citations

Approach to Decompensated Right Heart Failure in the Acute Setting

Levitt,

Williams,

Ahari

et al. 2024

JCM

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Soluble Suppression of Tumorigenicity 2 (sST2) in Patients with Predominantly Decompensated Right Heart Failure—A Prospective Observational Study

Dworok,

Hähnel,

Bannehr

et al. 2023

JCM

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Right heart failure is a major challenge in clinical practice. Soluble Suppression of Tumorigenicity-2 (sST2), a member of the interleukin-1-receptor family, may have clinical prognostic value. The aim of this study was to analyze whether sST2 correlates with signs of acute right heart decompensation. This prospective single-center study included 50 patients admitted for clinical signs of predominant right heart decompensation. Signs of reduced blood supply to other organs (e.g., renal function parameter, troponin T, NT-proBNP), diuretics, and signs of venous congestion (inferior vena cava (IVC) diameter) with fluid retention (weight gain, peripheral edema) resulting from reduced RV function were analyzed. The degree of peripheral edema was defined as none, mild (5–6 mm depressible, regression in 15–60 s) or severe (>7 mm depressible, regression in 2–3 min). sST2 levels were measured at the day of hospitalization. A total of 78.7% showed severe peripheral edema. The median concentration of sST2 was 35.2 ng/mL (25.–75. percentiles 17.2–46.7). sST2 is correlated with the peripheral edema degree (rSpearman = 0.427, p = 0.004) and the diameter of IVC (r = 0.786, p = 0.036), while NT-proBNP (r = 0.114, p = 0.456), troponin T (r = 0.123, p = 0.430), creatinine-based eGFR (r = −0.207, p = 0.195), or cystatin C-based eGFR (r = −0.032, p = 0.839) did not. sST2, but no other established marker, is correlated with peripheral and central fluid status in patients with decompensated right heart failure.

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How to Treat Right Heart Failure. Tips for Clinicians in Everyday Practice

Cited by 2 publications

References 61 publications

Approach to Decompensated Right Heart Failure in the Acute Setting

Approach to Decompensated Right Heart Failure in the Acute Setting

Soluble Suppression of Tumorigenicity 2 (sST2) in Patients with Predominantly Decompensated Right Heart Failure—A Prospective Observational Study

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