II. Causes
-
Pulmonary Arterial Hypertension (e.g. Pulmonary Embolism, ARDS, Pulmonary Hypertension)
- Worsened with Hypoxia, hypercarbia and acidosis
- Decreased contractility (e.g. right ventricular Myocardial Infarction or Myocarditis)
- Volume overload (e.g. Excessive volume Resuscitation as in multisystem Trauma, Sepsis)
III. Pathophysiology: Right Ventricle
- Right Ventricle is a "perfusion princess" (Sara Crager)
- Right ventricle is normally perfused in systole and diastole
- Contrast with the left ventricle which is only perfused in diastole
- Right ventricle poorly tolerates hypoperfusion and contractility decreases significantly
- Right ventricle systolic perfusion is decreased in progressive Right Heart Failure
- High pulmonary artery pressure especially with low systemic pressure (decreased pressure gradient)
- Hyperexpansion of the right ventricle results in a precipitous drop in right-sided contractility
- Contrast with left ventricle contractility with hyperexpansion which compensates (Starling Curve)
- Right Ventricle hyperexpansion also shifts septum left, decreases EF, decreases MAP and perfusion
- Left ventricle has an interdependence with the right ventricle
- Right ventricular dilates with decreased contractility and tricuspid regurgitation
- LV diastolic filling decreases with falling RV ejection fraction
- RV dilation also encroaches on the LV via their shared septum
- LV can temporarily compensate for reduced Stroke Volume with an increase in Heart Rate (Tachycardia)
- Reduced LV Cardiac Output increases pulmonary vascular resistance and right sided Afterload
- Other factors increasing pulmonary vascular resistance include hypercapnia, Atelectasis and Hypoxemia
- Positive Pressure Ventilation may also increase right sided Afterload
IV. Pathophysiology: Right Ventricular Spiral of Death
- Uncompensated Right Ventricular Failure results in hemodynamic collapse
- Right Ventricular Afterload (pulmonary artery pressures) increases
- Decreases right ventricular coronary pressure (esp. in systole) and results in RV ischemia
- Decreases right ventricular ejection fraction
- Increases right ventricular volume
- Interventricular Septum shifts left (interventricular interpedence), reducing left ventricular volume and cardiac ouput
- Decreases mean arterial pressure and further decreases right ventricular pefusion
V. Management
VI. Resources
- Scott Weingart. EMCrit 272 – Right Heart Failure with Sara Crager. EMCrit Blog. Published 4/29/20. Accessed 8/22/20.
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Related Studies
| Definition (MSH) | Heart failure involving the RIGHT VENTRICLE. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D006333 |
| SnomedCT | 128404006 |
| English | CARDIAC FAILURE RIGHT, Right-Sided Heart Failure, Heart Failure, Right Sided, Right Sided Heart Failure, Cardiac failure right, Failure right heart, Heart Failure, Right-Sided, rvf, cardiac failure right, failure right heart, heart failure right side, failure heart right sided, failure heart right sides, failure heart right, right heart failure, right ventricular failure, right-sided heart failure, right side heart failure, Right-sided heart failure, cardiac failure right heart, Right heart failure (diagnosis), Right heart failure, Right heart failure (disorder) |
| Dutch | falen rechter harthelft, hartfalen rechts, rechterhartfalen |
| French | Défaillance du coeur droit, Insuffisance cardiaque droite, Défaillance cardiaque droite, DEFAILLANCE CARDIAQUE DROITE |
| German | rechtes Herzversagen, Versagen rechts Herz, Herzversagen rechts, Rechtsinsuffizienz, Rechtsherzinsuffizienz, RECHTSHERZVERSAGEN |
| Italian | Insufficienza cardiaca destra, Scompenso cardiaco destro, Scompenso cardiaco del lato destro |
| Portuguese | Insuficiência cardíaca direita, INSUFICIENCIA CARDIACA DIREITA |
| Spanish | Insuficiencia del corazón derecho, Fallo del corazón derecho, Fallo cardiaco derecho, INSUFICIENCIA CARDIACA DERECHA, insuficiencia cardíaca derecha (trastorno), insuficiencia cardíaca derecha, insuficiencia del hemicardio derecho |
| Japanese | 右心不全, ｳｼﾝﾌｾﾞﾝ |
| Czech | Pravostranné srdeční selhání, Selhání pravého srdce, srdce - selhání pravostranné, pravostranné srdeční selhání, pravostranné selhání srdce |
| Hungarian | Jobbszívfél-elégtelenség, Jobb szívfél elégtelenség |
| Norwegian | Høyresidig hjertesvikt, Hjertesvikt, høyresidig |
Ontology: Right ventricular failure (C2939447)
| Definition (NCI) | Failure of proper functioning of the right ventricle, with venous engorgement, hepatic enlargement, and subcutaneous edema. |
| Definition (NCI_FDA) | Failure of proper functioning of the right ventricle, with venous engorgement, hepatic enlargement, and subcutaneous edema. |
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 266308000, 233925005, 195108009, 155375008, 367363000 |
| English | RHF - Right heart failure, RVF - R ventricular failure, RVF - Right ventricular failure, Right Ventricular Failure, RVF, Right ventricular failure, Failure;ventricular;right, Right ventricular failures, cardiac failure right ventricular, Right ventricular failure (diagnosis), Right heart failure, RIGHT VENTRICULAR FAILURE, FAILURE, RIGHT VENTRICULAR, VENTRICULAR FAILURE, RIGHT, Right ventricular insufficiency, Right ventricular failure (disorder), Right ventricular failure [Ambiguous], right ventricular failure |
| French | Défaillance ventriculaire droite, Défaillances ventriculaires droites, Insuffisance ventriculaire droite, FVD |
| Italian | Insufficienza ventricolare destra, Insufficienze ventricolari destre |
| Dutch | RVF, rechter ventriculaire insufficiëntie, rechterventrikelfalen, ventrikelfalen rechts |
| German | RVF, rechtsventrikulaere Insuffizienz, Rechtsherzinsuffizienzen, Rechtsherzinsuffizienz |
| Portuguese | Insuficiência ventricular direita, Insuficiência do ventrículo direito, Insuficiências do ventrículo direito |
| Spanish | Fallo ventricular derecho, IVD, falla cardíaca derecha, insuficiencia del ventrículo derecho (trastorno), insuficiencia del ventrículo derecho, Insuficiencia ventricular derecha, Insuficiencias del ventrículo derecho |
| Japanese | 右心室不全, 右室不全, ｳｼﾂﾌｾﾞﾝ, ｳｼﾝｼﾂﾌｾﾞﾝ |
| Czech | Selhání pravé komory, Selhání pravé srdeční komory, Selhání pravé komory srdeční, Insuficience pravé komory |
| Hungarian | Jobb ventricularis elégtelenség, Jobb kamrai elégtelenség, Jobb kamrai elégtelenségek, RVF |
