A Right heart failure (RHF) can result from many cardiac, pulmonary, and systemic pathologies. Common causes of RHF include pulmonary embolism, left heart failure, congenital heart disease, chronic lung disease, acute myocardial infarction, infiltrative disease, infectious disease, and valvular abnormalities.
Our recent issue Emergency Department Management of Patients With Right Heart Failure describes the pathophysiology of right heart failure and offers an evidence-based approach to the diagnosis, management, and disposition of both acute and chronic RHF.
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Here are a few key points:
- Right heart failure (RHF) is the common endpoint of numerous cardiac, pulmonary, and systemic pathologies.
- Recognition of RHF in the ED is vitally important, as it can dramatically alter the management of commonly presenting conditions.
- Right heart function is dictated by 3 physiologic domains: (1) resistance to right ventricular ejection (afterload) via the pulmonary artery; (2) right ventricular systolic and diastolic pump function; and (3) right heart filling (preload) via systemic venous return. (See Figure 1.)
- The possible causes of RHF are vast, and more than one acute or chronic etiology may contribute. See Table 2 for etiologies of acute and acute-on-chronic RHF. Table 4 lists common ED diagnoses associated with acute RHF.
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