Dr. Gautam Ramani is an expert in pulmonary hypertension as well as the evaluation and management of patients with acute right heart failure. Â In this core content lecture, Dr. Ramani will discuss the evaluation of these critically-ill patients, hemodynamic strategies, and treatment options for patients with acute RHF.
Pearls
- In patients who are actively beta-blocked with acute right heart failure, consider using milrinone and calcium to improve inotropy.
- Even short periods of hypotension in patients with RHF can cause them to crash and burn quickly. Â Low MAPs lead to low RCA perfusion pressure which can result in worsening RV ischemia, contractility, and output.
- Consider vasopressin over norepinephrine win patients with RHF and hypotension. Â Theoretically, vasopressin has less on an effect on pulmonary vascular resistance when compared to norepinephrine.
- It is extraordinarily difficult to determine volume status in patients with RHF. Â Consider invasive monitoring/evaluation (right heart catheterization, Swan-Ganz catheter) to determine whether the patient would benefit from diuresis or volume expansion.
