TY - CHAP M1 - Book, Section TI - Acute Right Heart Syndromes A1 - Douglas, Ivor S. A2 - Schmidt, Gregory A. A2 - Kress, John P. A2 - Douglas, Ivor S. Y1 - 2023 N1 - T2 - Hall, Schmidt and Wood’s Principles of Critical Care, 5th Edition AB - KEY POINTSRight heart syndromes (RHS) as a cause of hemodynamic instability and shock are less common than left heart dysfunction but recognizing them requires a high level of vigilance.RHS result from a combination of pressure or volume overload and impaired right ventricular (RV) contractility. Progression to acute right heart failure (the combination acute pulmonary hypertension with profound RV systolic and diastolic dysfunction) involved pathological interventricular interdependence, RV ischemia and spiraling end-organ dysfunction.Clues to recognizing RHS as a cause of shock include a history of a condition that is associated with pulmonary hypertension, elevated neck veins, peripheral edema greater than pulmonary edema, or a right-sided third heart sound, in addition to electrocardiographic, radiographic, and echocardiographic findings.Plasma biomarkers are nonspecific but echocardiography is extremely valuable, not only for demonstrating the presence of RHS but also for guiding hemodynamic management.Progressive right heart shock can be worsened by excessive fluid infusion, concomitant left ventricular failure, inappropriate application of extrinsic positive end-expiratory pressure (PEEP) and hypoxia.The drug of choice for resuscitation to reduce systemic oxygen demand while improving oxygen delivery is dobutamine, initially infused at 5 μg/kg/min. Systemically active vasoconstrictors may provide additional benefit.Inhaled prostacyclin and oral PDE inhibitors (eg, sildenafil) or extracorporeal mechanical-assist devices may be beneficial in improving pulmonary hemodynamics and oxygenation but may not improve survival. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/11/14 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1201882262 ER -