Professor of Anesthesiology, and AirMed Assistant Medical Director University of Utah Health Salt Lake City, Utah
Disclosure(s): No financial relationships to disclose
We all think about left ventricular failure when faced with a patient with cardiogenic shock, but right ventricular failure is often a co-existing or primary clinical problem, and the management is different, with little margin of error for treatment. Acutely increased RV afterload (pressure overload) or distention (volume overload) can rapidly progress to RV ischemia and failure, resulting in a lethal positive feedback loop. We'll discuss why the RV can't take a joke (normal and pathologic physiology) common etiologies of acute RV failure, making the diagnosis, and rapid treatment options for the critical care transport environment. This will include treating the primary problem, evaluating and optimizing preload, options to minimize RV afterload, focusing on reducing pulmonary vascular resistance, increasing RV coronary perfusion to reduce ischemia, and finally options and considerations for inotropic support. We'll wrap up by presenting a couple of cases with initially unclear diagnosis, discuss common pitfalls, and then review optimal management strategies.
Learning Objectives:
Upon completion, participant will be able to describe the reasons why the RV is so prone to failure from acute volume or pressure overload
Upon completion, participant will be able to list common etiologies and presentations of patients with acute RV failure
Upon completion, participant will be able to and quickly intervene to improve RV function and to prevent cardiovascular collapse
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