Principles of Critical Care > Part III. Cardiovascular Disorders > Chapter 26. Acute Right Heart Syndromes Ivor S. Douglas,  Gregory A. Schmidt

Key Points

"In the majority of patients with shock due to "pump failure," assessment is focused appropriately on the left ventricle. However, in a substantial minority of patients, right heart dysfunction is the cause of shock. Examples include acute pulmonary embolism (PE), other causes of acute right heart pressure overload (e.g., acute respiratory distress syndrome [ARDS] treated with positive pressure ventilation), acute deterioration in patients with chronic pulmonary hypertension, and right ventricular infarction. Although right ventricular infarction differs from the other right heart syndromes (RHS) in that the pulmonary artery pressure is not high, in many other regards right ventricular infarction resembles the other syndromes, so we will consider them together. Failure to consider the right heart in the differential diagnosis of shock risks incomplete or inappropriate treatment of the shock. It would be hard to overemphasize the importance of echocardiography, both in aiding the recognition of the right heart syndromes and in guiding management. In this chapter we review the notable features that distinguish the right heart from the left, describe the themes that unify the acute RHS and allow their recognition, discuss the pathophysiology and differential diagnosis of RHS, and review their management...."