RT Book, Section A1 Walley, Keith R. A2 Schmidt, Gregory A. A2 Kress, John P. A2 Douglas, Ivor S. SR Print(0) ID 1201801087 T1 Ventricular Dysfunction in Critical Illness T2 Hall, Schmidt and Wood’s Principles of Critical Care, 5th Edition YR 2023 FD 2023 PB McGraw Hill PP New York, NY SN 9781264264353 LK accessanesthesiology.mhmedical.com/content.aspx?aid=1201801087 RD 2024/09/12 AB KEY POINTSCardiac pump dysfunction may be due to ventricular dysfunction, compression by surrounding structures (eg, cardiac tamponade), increased afterload, valvular dysfunction, or abnormal heart rate and rhythm.Ventricular dysfunction may be due to decreased systolic contractility or increased diastolic stiffness and may involve right or left ventricles.Systemic vascular factors controlling venous return, and their interaction with cardiac pump function, must be considered to identify and treat causes of inadequate cardiac output.Myocardial ischemia, relative to demand, is the most common acute reversible contributor to decreased contractility, but exogenous toxins and drugs (β-blockers, Ca2+ channel blockers, etc), a myocardial inflammatory response (due to ischemia-reperfusion, sepsis, etc.), hypoxemia, acidosis, ionized hypocalcemia and other electrolyte abnormalities, and hypo- and hyperthermia also contribute.Management of acute-on-chronic heart failure progressively includes oxygen; optimizing preload with diuretics, morphine, and nitrates or fluid infusion for hypovolemia; afterload reduction (including positive pressure ventilation); increasing contractility using catecholamines or phosphodiesterase inhibitors; antiarrhythmic drugs and resynchronization using biventricular pacing; mechanical ventricular assist devices and extracorporeal membrane oxygenation (ECMO); and cardiac transplantation.Point-of-care ultrasound (POCUS) provides key initial information and allows subsequent monitoring of therapeutic effects. It can be supplemented by a subsequent comprehensive echocardiographic exam for additional information.