Emergency Department Management of Patients With Right Heart Failure
6
Publication Date: February 2024 (Volume 26, Number 2)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 02/01/2027.
Authors
Daniel S. Brenner, MD, PhD
Assistant Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
Onyedika J. Ilonze, MD
Division of Cardiovascular Medicine, Krannerat Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, IN
Shelby Beil, MD
Fellow, Indiana University School of Medicine, Department of Pulmonary and Critical Care Medicine, Indianapolis, IN
Kellie Kaneshiro, AMLS
Librarian, Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN
Nicholas E. Harrison, MD, MSc
Assistant Professor, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
Peer Reviewers
James Morris, MD, MPH, FACEP
Program Director, Emergency Medicine Residency, Texas Tech University Health Sciences Center, Lubbock, TX
Kestrel Reopelle, MD, MEd
Assistant Professor; Assistant Program Director, Residency in Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Abstract
Right heart failure (RHF) can result from many cardiac, pulmonary, and systemic pathologies. Common causes of RHF include pulmonary embolism, left heart failure, congenital heart disease, chronic lung disease, acute myocardial infarction, infiltrative disease, infectious disease, and valvular abnormalities. Acute and chronic RHF confer a high risk for morbidity and mortality in the acute care setting, and interventions commonly used in emergency care can prompt acute decompensation if the RHF is not recognized. The severity of presentation may range from compensated clinically silent cardiovascular dysfunction to venous congestion, multiorgan failure, and circulatory collapse. This review describes the pathophysiology of right heart failure and offers an evidence-based approach to the diagnosis, management, and disposition of both acute and chronic RHF.
Case Presentations
CASE 1
A 40-year-old woman presents with dyspnea, tachycardia, and hemoptysis…
Her vital signs are: temperature, 36.9°C; heart rate, 125 beats/min; blood pressure, 120/65 mm Hg; respiratory rate, 24 breaths/min; and oxygen saturation, 94%.
She takes estrogen-containing medications, and reports that she recently had a cross-continental airplane flight.
As you place initial orders, you consider whether transthoracic echocardiography would aid in her evaluation and management…
CASE 2
A 64-year-old man with a history of heart failure reports severe fatigue and dyspnea…
His vital signs are: temperature, 36.5°C; heart rate, 115 beats/min; blood pressure, 150/90 mm Hg; and respiratory rate, 26 breaths/min. In the ED, his resting oxygen saturation is 93%.
He states that he is compliant with his diuretic therapy, but he has developed worsened lower extremity edema.
What aspects of cardiac function most acutely correspond to his symptoms and risk for adverse events?
CASE 3
A 52-year-old woman with COVID-19 and severe respiratory distress develops hemodynamic instability immediately after you intubate her…
Her vital signs are: temperature, 37.5°C; heart rate, 130 beats/min; blood pressure, 75/42 mm Hg; and respiratory rate, 22 breaths/min.
What are the likely causes of her shock, and what should you do to stabilize her?
Accreditation:
EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
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