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Current Concepts in Right Heart Failure

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Dr Mandeep Mehra, USA    04 January 2018

  1. Differences between the RV and LV structure, inform management. The RV is unique in cellular physiology and in therapeutic response from the LV.
  2. Alterations in metabolism in RV include increased oxygen requirement, lower oxygen extraction reserve and higher dependence on coronary flow and lower glucose-based oxygen consumption/gm of myocardium.
  3. Key principles: Considerations and goals: Increased preload, in and of itself, rarely causes RHF; LV function determines RV function; RV coronary perfusion is dependent on aortic perfusion pressure; AV synchrony and tachycardia control; abnormal RV adaptation (chronic).
  4. The unique procedures for RV rescue are atrial septostomy, aorto-pulmonary windows and mechanical support-ECMO, Tandem, RV impella.

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