emDOCs - November 22, 2022 - By Matt Kostura, Courtney Smalley
Reviewed by: Marina Boushra; Alex Koyfman; Brit Long
Pitfalls and Pearls
- Keep RHF on the differential diagnosis in patients with underlying pathology that affects the right heart and lungs.
- Treat the underlying cause of an acute RHF exacerbation while optimizing preload, afterload, and contractility.
- POCUS, along with patient history and physical exam, is key to assessing patient volume status.
- Dobutamine or milrinone can improve the contractility of the RV. Phenylephrine should be avoided when possible due to increase in PVR.
- Avoid systemic hypotension and be quick to use norepinephrine and/or vasopressin if the patient decompensates.
- Avoid intubation when possible, utilizing HFNC or NIPPV first, as mechanical ventilation worsens RV hemodynamics.