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Acute right ventricular failure-from pathophysiology to new treatments

Mebazaa, A; Karpati, P; Renaud, E and Algotsson, Lars LU (2004) In Intensive Care Medicine 30(2). p.185-196
Abstract
The right ventricle (RV) provides sustained low-pressure perfusion of the pulmonary vasculature, but is sensitive to changes in loading conditions and intrinsic contractility. Factors that affect right ventricular preload, afterload or left ventricular function can adversely influence the functioning of the RV, causing ischaemia and right ventricular failure (RVF). As RVF progresses, a pronounced tricuspid regurgitation further decreases cardiac output and worsens organ congestion. This can degenerate into an irreversible vicious cycle. The effective diagnosis of RVF is optimally performed by a combination of techniques including echocardiography and catheterisation, which can also be used to monitor treatment efficacy. Treatment of RVF... (More)
The right ventricle (RV) provides sustained low-pressure perfusion of the pulmonary vasculature, but is sensitive to changes in loading conditions and intrinsic contractility. Factors that affect right ventricular preload, afterload or left ventricular function can adversely influence the functioning of the RV, causing ischaemia and right ventricular failure (RVF). As RVF progresses, a pronounced tricuspid regurgitation further decreases cardiac output and worsens organ congestion. This can degenerate into an irreversible vicious cycle. The effective diagnosis of RVF is optimally performed by a combination of techniques including echocardiography and catheterisation, which can also be used to monitor treatment efficacy. Treatment of RVF focuses on alleviating congestion, improving right ventricular contractility and right coronary artery perfusion and reducing right ventricular afterload. As part of the treatment, inhaled nitric oxide or prostacyclin effectively reduces afterload by vasodilating the pulmonary vasculature. Traditional positive inotropic drugs enhance contractility by increasing the intracellular calcium concentration and oxygen consumption of cardiac myocytes, while vasopressors such as norepinephrine increase arterial blood pressure, which improves cardiac perfusion but increases afterload. A new treatment, the calcium sensitiser, levosimendan, increases cardiac contractility without increasing myocardial oxygen demand, while preserving myocardial relaxation. Furthermore, it increases coronary perfusion and decreases afterload. Conversely, traditional treatments of circulatory failure, such as mechanical ventilation and volume loading, could be harmful in the case of RVF. This review outlines the pathophysiology, diagnosis and treatment of RVF, illustrated with clinical case studies. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
inotropic agents, vasodilator agents, heart failure, levosimendan, pathophysiology, pharmacology
in
Intensive Care Medicine
volume
30
issue
2
pages
185 - 196
publisher
Springer
external identifiers
  • pmid:14618229
  • wos:000188707800004
  • scopus:1342310815
ISSN
0342-4642
DOI
10.1007/s00134-003-2025-3
language
English
LU publication?
yes
id
defd22c2-84de-4db4-b457-b821fefaefe5 (old id 288742)
date added to LUP
2007-08-03 12:53:22
date last changed
2017-10-22 03:39:47
@article{defd22c2-84de-4db4-b457-b821fefaefe5,
  abstract     = {The right ventricle (RV) provides sustained low-pressure perfusion of the pulmonary vasculature, but is sensitive to changes in loading conditions and intrinsic contractility. Factors that affect right ventricular preload, afterload or left ventricular function can adversely influence the functioning of the RV, causing ischaemia and right ventricular failure (RVF). As RVF progresses, a pronounced tricuspid regurgitation further decreases cardiac output and worsens organ congestion. This can degenerate into an irreversible vicious cycle. The effective diagnosis of RVF is optimally performed by a combination of techniques including echocardiography and catheterisation, which can also be used to monitor treatment efficacy. Treatment of RVF focuses on alleviating congestion, improving right ventricular contractility and right coronary artery perfusion and reducing right ventricular afterload. As part of the treatment, inhaled nitric oxide or prostacyclin effectively reduces afterload by vasodilating the pulmonary vasculature. Traditional positive inotropic drugs enhance contractility by increasing the intracellular calcium concentration and oxygen consumption of cardiac myocytes, while vasopressors such as norepinephrine increase arterial blood pressure, which improves cardiac perfusion but increases afterload. A new treatment, the calcium sensitiser, levosimendan, increases cardiac contractility without increasing myocardial oxygen demand, while preserving myocardial relaxation. Furthermore, it increases coronary perfusion and decreases afterload. Conversely, traditional treatments of circulatory failure, such as mechanical ventilation and volume loading, could be harmful in the case of RVF. This review outlines the pathophysiology, diagnosis and treatment of RVF, illustrated with clinical case studies.},
  author       = {Mebazaa, A and Karpati, P and Renaud, E and Algotsson, Lars},
  issn         = {0342-4642},
  keyword      = {inotropic agents,vasodilator agents,heart failure,levosimendan,pathophysiology,pharmacology},
  language     = {eng},
  number       = {2},
  pages        = {185--196},
  publisher    = {Springer},
  series       = {Intensive Care Medicine},
  title        = {Acute right ventricular failure-from pathophysiology to new treatments},
  url          = {http://dx.doi.org/10.1007/s00134-003-2025-3},
  volume       = {30},
  year         = {2004},
}