TY - CHAP M1 - Book, Section TI - Acute Right Heart Syndromes A1 - Douglas, Ivor S. A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. PY - 2015 T2 - Principles of Critical Care, 4e AB - Right 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 RV contractility. Progression to acute cor pulmonale (the combination of acute pulmonary hypertension with profound RV systolic and diastolic dysfunction) results in 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 per minute. Systemically active vasoconstrictors may provide additional benefit.Inhaled nitric oxide or 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 Education CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1107717392 ER -