Wednesday, April 18, 2018

Pulmonary Hypertension and RVF

A guide to the initial emergency department management of patients with 
pulmonary hypertension and right ventricular failure
First10EM - By Justin Morgenstern - April 16, 2018
..."In the setting of pulmonary hypertension, the right ventricle is impaired both mechanically and by ischemia. Increased RV pressure leads to bowing of the septum into the left ventricle, which leads to decreased LV filling and decreased cardiac output. Right ventricular stretching will cause tricuspid regurgitation, which will also result in decreased cardiac output. Any decrease in cardiac output will result in decreased perfusion to the right ventricle. Finally, increased pulmonary pressures increase the RV wall tension and induce RV hypertrophy, which decreases perfusion to the right ventricle, ultimately worsening cardiac output further. (True experts are probably cringing at this over-simplified explanation, but I think it is enough to understand the management, which is my priority.)...."
RV spiral of death FRIST10EM.png