1. Morning Report
Anne Lachiewicz
April 5, 2010

2. Diagnostic signs Kussmaul’s sign
- JVP increases with respiration instead of declines
- Reflects an increase in right atrial pressures (R-sided HF)
Hepatojugular reflux
- Distension of the JV induced by applying manual pressure over the liver.
- Reflects elevated PCWP (L-sided HF)

3. Causes of
Right
Ventricular
Failure

4. Clinical evaluation Fatigue, lethargy, dyspnea, early satiety
Elevated JVP
TR w/ murmur
Kussmaul’s sign
Right-sided S3 gallop
Peripheral cyanosis & edema
Hepatomegaly & ascites
Elevated Cr, lactate, BNP, troponin, transaminases & bilirubin
Decreased Na & HCO3
NO PND or orthopnea

5. Normal pulmonary pressures
Pulmonary hypertension

6. Effect of increased afterload/PAP on the RV

7. Treatment/Prognosis
No specific therapies for chronic RV failure – identify & correct the underlying physiologic derangements (e.g. Tx L-sided HD).
Appropriate diuresis may decrease RV loading w/o negatively impacting LV preload & cardiac output.
In pts with chronic L-sided HF, RV dysfunction is an independent predictor of reduced exercise capacity & survival.

8. References
Brieke, A. and DeNofrio, D. Right ventricular dysfunction in chronic dilated cardiomyopathy and heart failure.
Mahmud, M. and Champion, H. Right ventricular failure complicating heart failure: pathophysiology, significance, and management strategies. Current cardiology reports, 2007:
Matthews, J. and McLaughlin V. Acute right ventricular failure in the setting of acute pulmonary embolism or chronic pulmonary hypertension: a detailed review of the pathophysiology, diagnosis, and management. Current cardiology Reviews, 2008:49-59.
McDonald, M. and Ross, H. Trying to succeed when the right ventricle fails. Current opinions in cardiology, 2009: