Management of the Critically Ill Patient with Pulmonary Arterial Hypertension and Right Heart Failure

John Granton; Ricardo Teijeiro-Paradis

doi:10.1016/j.ccm.2022.04.005

Management of the Critically Ill Patient with Pulmonary Arterial Hypertension and Right Heart Failure

Clin Chest Med. 2022 Sep;43(3):425-439. doi: 10.1016/j.ccm.2022.04.005.

Authors

John Granton¹, Ricardo Teijeiro-Paradis²

Affiliations

¹ University of Toronto, Pulmonary and Critical Care Medicine, University Health Network, 9-9023 MARS Building, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada. Electronic address: John.granton@uhn.ca.
² Interdepartmental Division of Critical Care, University of Toronto, University Health Network, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada.

PMID: 36116812
DOI: 10.1016/j.ccm.2022.04.005

Abstract

Right ventricular (RV) failure is a recognized complication of pulmonary hypertension (PH). Pregnancy and surgery represent unique challenges to the patient with PH and require input from an interprofessional team. Approach to treatment must embrace sound physiologic principles that are based on optimization of RV preload, contractility, and afterload to improve cardiac function and tissue perfusion before the onset of multiorgan dysfunction. Failure of medical therapy needs to be recognized before the onset of irreversible shock. When appropriate, eligible patients should be considered for mechanical circulatory support as a bridge to recovery or transplantation.

Keywords: Echocardiography; Extracorporeal support; Heart failure; Pulmonary hypertension; Right ventricle.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Critical Illness / therapy
Heart Failure* / complications
Heart Failure* / therapy
Humans
Hypertension, Pulmonary* / complications
Hypertension, Pulmonary* / therapy
Pulmonary Arterial Hypertension*
Ventricular Dysfunction, Right* / complications
Ventricular Dysfunction, Right* / therapy