EMOttawa - By Alie Wudwud - March 30, 2023
…Recognition and the appropriate management of acute RV failure is critical in the emergency department. Routine interventions often performed early in a patient’s ED course and a delay in definitive therapy can lead to deterioration in these patients. It is important for us to be comfortable with the ED management of acute RV failure. There is, truthfully, not a robust body of evidence to guide ED management. Recently, more attention has been placed in understanding RV anatomy, physiology and dysfunction, and most of the recommendations now around managing RV failure come from an understanding of this pathophysiology. Before getting straight to the management of these patients, we first need to briefly review the pathophysiology of acute pulmonary hypertension and RV failure. In this post, we will:
- Provide an overview for the pathophysiology of right ventricular (RV) failure in acute pulmonary embolism (PE)
- Outline the principles of managing a patient with RV failure and acute PE
- Provide a brief review of the evidence for thrombolytics and other therapy options in an acute PE
- Discuss the role of Thrombosis and PERT in the management of acute PE