| Impaired RV contractility | Volume overload | Increased RV afterload |
| RV infarction | TR or PR | Pulmonary hypertension |
| Congenital cardiac disease | ASD/VSD | PE |
| Volume overload | Carcinoid syndrome | OSA |
| Cardiomyopathy | LV failure |
Right Ventricular Failure
Right Ventricular Failure
RV failure isn't explicitly mentioned in the curriculum, falling under the generic umbrella of heart failure.
These brief notes may therefore suffice; there's greater detail in the resources below.
Resources
Hypertrophy
- Increased afterload leads to prolonged isovolumetric contraction time
- This causes increased myocardial wall stress
- In order to maintain stroke volume, the RV dilates and, over time, becomes hypertrophied
LV failure
- As the RV dilates, the interventricular septum bulges into the LV cavity
- The pericardium limits ventricular expansion, so an increase in RV cavity size necessitates a decrease in LV cavity size
- The effect of this is impaired LV filling and therefore reduced LV function
Perioperative management of the patient with RV failure
Monitoring and access
- AAGBI
- Consider A-line ± CVC
- Consider CO monitoring
- ± Depth of anaesthesia monitoring to minimise deleterious cardiovascular effects of excessive anaesthesia
Haemodynamic goals
| Cardiovascular feature | Goal of management |
| Heart rate | Avoid tachycardia or bradycardia, to preserve diastolic time |
| Heart rhythm | Maintain sinus rhythm with rapid treatment of arrhythmia |
| Preload | Maintain adequate RV preload |
| Afterload | Avoid increases in PVR (see below) |
| Contractility | Avoid myocardial depression i.e. maintain contractility using positive inotropy |
Avoid increases in PVR
| Factors increasing PVR |
| ↑ PaCO2 |
| ↓ phH i.e. acidosis |
| ↓ PaO2 |
| Extremes of lung volume |
| PEEP |
| Endogenous vasoconstrictors AT-II, 5-HT, TXA2 |
| Catecholamines |