RV Failure & Pulmonary Hypertension

• A decompensated RV produces jugular distention, edema, and hypotension with clear lungs; echo reveals a dilated hypokinetic RV with septal flattening.
• Avoid intubation if you can, since induction drops preload; if unavoidable, use ketamine/etomidate with pressors already running.
• Preserve RV perfusion with noradrenaline ± inotrope (dobutamine/milrinone), and AVOID overhydration; the failing RV drowns.
• Lower afterload by correcting hypoxia, hypercapnia, and acidosis, bridging with inhaled prostacyclin/NO.
• Pulmonary hypertension is defined by right-heart catheterization as mPAP >20 mm Hg at rest. Pre-capillary pulmonary hypertension additionally requires PAWP ≤15 mm Hg and PVR >2 Wood units.

First tests: Bedside echocardiography, 12-lead ECG, Sodium, potassium, bicarbonate, urea and creatinine, Liver biochemistry.

Only if indicated: CT pulmonary angiography, Right-heart catheterization, BNP or NT-proBNP.

Repeat monitoring: Urine output and fluid balance.

• Mechanisms of Decompensated Right Ventricular Failure
• Diagnostic Route in Suspected Right Ventricular (RV) Failure
• Treatment of Decompensated Right Ventricular (RV) Failure