1. Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology
- Author
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Harjola, V-P, Mebazaa, A, Celutkiene, J, Bettex, D, Bueno, H, Chioncel, O, Crespo-Leiro, MG, Falk, V, Filippatos, G, Gibbs, S, Leite-Moreira, A, Lassus, J, Masip, J, Mueller, C, Mullens, W, Naeije, R, Nordegraaf, AV, Parissis, J, Riley, JP, Ristic, A, Rosano, G, Rudiger, A, Ruschitzka, F, Seferovic, P, Sztrymf, B, Vieillard-Baron, A, Yilmaz, MB, Konstantinides, S, University of Zurich, Harjola, Veli-Pekka, [Harjola, Veli-Pekka] Univ Helsinki, Helsinki Univ Hosp, Dept Emergency Med & Serv, Emergency Med, Helsinki, Finland -- [Mebazaa, Alexandre] Univers Paris Diderot, Sorbonne Paris Cite, Paris, France -- [Mebazaa, Alexandre] AP HP, Inserm U942, Paris, France -- [Mebazaa, Alexandre] Hop Univ St Louis Lariboisiere, AP HP, Dept Anaesthesia & Crit Care, Paris, France -- [Celutkiene, Jelena] Vilnius Univ, Fac Med, Clin Cardiac & Vasc Dis, Vilnius, Lithuania -- [Bettex, Dominique] Univ Zurich Hosp, Inst Anaesthesiol, Zurich, Switzerland -- [Bueno, Hector] Hosp Univ 12 Octubre, CNIC, Madrid, Spain -- [Bueno, Hector] Hosp Univ 12 Octubre, Inst Invest I 12, Madrid, Spain -- [Bueno, Hector] Hosp Univ 12 Octubre, Dept Cardiol, Madrid, Spain -- [Bueno, Hector] Univ Complutense Madrid, E-28040 Madrid, Spain -- [Chioncel, Ovidiu] Univ Med & Pharm Carol Davila, Inst Emergency Cardiovasc Dis, Bucharest, Romania -- [Crespo-Leiro, Maria G.] CHUAC, Complexo Hosp Univ A Coruna, Unidad Insuficiencia Cardiaca Avanzada & Trasplan, La Coruna, Spain -- [Falk, Volkmar] Deutsch Herzzentrum Berlin, Dept Cardiothorac & Vasc Surg, Berlin, Germany -- [Filippatos, Gerasimos] Athens Univ Hosp Attikon, Athens, Greece -- [Gibbs, Simon -- Riley, Jillian P.] Univ London Imperial Coll Sci Technol & Med, London, England -- [Leite-Moreira, Adelino] Univ Porto, Fac Med, Dept Fisiol & Cirurgia Cardiotorac, Rua Campo Alegre 823, P-4100 Oporto, Portugal -- [Lassus, Johan] Univ Helsinki, Helsinki Univ Hosp, Cardiol, Helsinki, Finland -- [Masip, Josep] Univ Barcelona, Hosp St Joan Despi Moises Broggi, Barcelona, Spain -- [Masip, Josep] Univ Barcelona, Hosp Gen Hosp, Barcelona, Spain -- [Mueller, Christian] Univ Basel Hosp, Dept Cardiol, CH-4031 Basel, Switzerland -- [Mueller, Christian] Univ Basel Hosp, CRIB, CH-4031 Basel, Switzerland -- [Mullens, Wilfried] Hasselt Univ, Fac Med & Life Sci, Genk Biomed Res Inst, Dept Cardiol,Ziekenhuis Oost Limburg, Diepenbeek, Belgium -- [Nordegraaf, Anton Vonk] Free Univ Brussels, Dept Phys, Fac Med, 808 Route Lennik, Brussels, Belgium -- [Parissis, John] Vrije Univ Amsterdam, Medisch Centrum, Amsterdam, Netherlands -- [Parissis, John] Attikon Univ Hosp, Athens, Greece -- [Ristic, Arsen] Clin Ctr Serbia, Dept Cardiol, Belgrade, Serbia -- [Ristic, Arsen] Univ Belgrade, Sch Med, Belgrade, Serbia -- [Rosano, Giuseppe] IRCCS San Raffaele Hosp Roma, Rome, Italy -- [Rosano, Giuseppe] St Georges Univ London, Cardiovasc & Cell Sci Inst, London, England -- [Rudiger, Alain] Univ Hosp, Cardiosurg Intens Care Unit, Zurich, Switzerland -- [Ruschitzka, Frank] Univ Heart Ctr Zurich, Dept Cardiol Heart Failure Clin & Transplantat, Zurich, Switzerland -- [Seferovic, Petar] Univ Belgrade, Sch Med, Dept Internal Med, Belgrade, Serbia -- [Seferovic, Petar] Univ Belgrade, Heart Failure Ctr, Med Ctr, Belgrade, Serbia -- [Sztrymf, Benjamin] Hop Univ Paris Sud, AP HP, Hop Antoine Beclere, Reanimat Polyvalente, Clamart, France -- [Vieillard-Baron, Antoine] INSERM U 1018, CESP, UVSQ, Team 5,EpReC Renal & Cardiovasc Epidemiol, Villejuif, France -- [Vieillard-Baron, Antoine] Univ Hosp Ambroise Pare, AP HP, Boulogne, France -- [Yilmaz, Mehmet Birhan] Cumhuriyet Univ, Fac Med, Dept Cardiol, Sivas, Turkey -- [Konstantinides, Stavros] Univ Med Ctr Mainz, CTH, Mainz, Germany -- [Konstantinides, Stavros] Democritus Univ Thrace, Dept Cardiol, Alexandroupolis, Greece, YILMAZ, MEHMET BIRHAN -- 0000-0002-8169-8628, Lamonaca, Palma -- 0000-0003-4891-2255, Celutkiene, Jelena -- 0000-0003-3562-9274, Chioncel, Ovidiu -- 0000-0002-3197-3628, Bueno, Hector -- 0000-0003-0277-7596, YILMAZ, Mehmet Birhan -- 0000-0002-8169-8628, Rudiger, Alain -- 0000-0001-7943-7624, Leite-Moreira, Adelino -- 0000-0001-7808-3596, Mebazaa, Alexandre -- 0000-0001-8715-7753, and Falk, Volkmar -- 0000-0002-7911-8620
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Pulmonary Circulation ,Cardiac & Cardiovascular Systems ,INTENSIVE-CARE-UNIT ,10216 Institute of Anesthesiology ,Ventricular Dysfunction, Right ,RESPIRATORY-DISTRESS-SYNDROME ,Heart failure ,610 Medicine & health ,TROPONIN-T ASSAY ,1102 Cardiovascular Medicine And Haematology ,2705 Cardiology and Cardiovascular Medicine ,ASSIST DEVICE ,Humans ,cardiovascular diseases ,Right ventricular dysfunction ,Cardiogenic shock ,INFERIOR MYOCARDIAL-INFARCTION ,Heart Failure ,Science & Technology ,Right ventricular function ,ACUTE COR-PULMONALE ,Cardiovascular System & Hematology ,CARDIOVASCULAR-DISEASE ,Echocardiography ,Intensive care ,CARDIOGENIC-SHOCK ,Cardiovascular System & Cardiology ,cardiovascular system ,10209 Clinic for Cardiology ,ARTERIAL-HYPERTENSION ,Life Sciences & Biomedicine ,TASK-FORCE - Abstract
WOS: 000373160000002, PubMed ID: 26995592, Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a cascade leading to increasing venous congestion. Ventricular interdependence results in impaired left ventricular filling, a decrease in left ventricular stroke volume, and ultimately low cardiac output and cardiogenic shock. Identification and treatment of the underlying cause of RV failure, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmia, is the primary management strategy. Judicious fluid management, use of inotropes and vasopressors, assist devices, and a strategy focusing on RV protection for mechanical ventilation if required all play a role in the clinical care of these patients. Future research should aim to address the remaining areas of uncertainty which result from the complexity of RV haemodynamics and lack of conclusive evidence regarding RV-specific treatment approaches.
- Published
- 2016
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