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Right Heart Failure
John D. Grizzard, MD; Lowie M. R. Van Assche, MD; Raymond J. Kim, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        TERMINOLOGY

        • Abbreviations

          • Right heart failure (RHF)
        • Definitions

          • Right ventricular (RV) dysfunction that results in either inadequate RV systolic forward flow to maintain normal cardiac output or diastolic filling impairment leading to abnormally high venous filling pressures or both
            • Forward and backward components of RHF often coexist but manifest differently
              • Forward failure manifests as decreased RV ejection fraction (RVEF), increased pulmonary circulation time, decreased pulmonary artery (PA) velocity
              • Backward failure results in peripheral edema, hepatic congestion, ascites, pleural effusions
          • Most often due to either left heart failure (LHF) or pulmonary hypertension (PH)
          • Often results from PH resulting in maladaptive RV hypertrophy and later failure
            • Cor pulmonale = RV failure due to pulmonary parenchymal or vascular disease
            • Acute RHF may be seen with massive pulmonary emboli
          • RHF occurring without LHF is identified when abnormally high right atrial pressures are accompanied by normal capillary wedge pressures

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Echocardiographic Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      Selected References

                                      1. Gorter TM et al: Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 20(1):16-37, 2018
                                      2. Yancy CW et al: 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Card Fail. 23(8):628-651, 2017
                                      3. Aschauer S et al: The right heart in heart failure with preserved ejection fraction: insights from cardiac magnetic resonance imaging and invasive haemodynamics. Eur J Heart Fail. 18(1):71-80, 2016
                                      4. Simon MA: Assessment and treatment of right ventricular failure. Nat Rev Cardiol. 10(4):204-18, 2013
                                      5. Mertens LL et al: Imaging the right ventricle--current state of the art. Nat Rev Cardiol. 7(10):551-63, 2010
                                      6. Braunwald E et al: Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia: W. B. Saunders. 454-472, 2015
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Right heart failure (RHF)
                                            • Definitions

                                              • Right ventricular (RV) dysfunction that results in either inadequate RV systolic forward flow to maintain normal cardiac output or diastolic filling impairment leading to abnormally high venous filling pressures or both
                                                • Forward and backward components of RHF often coexist but manifest differently
                                                  • Forward failure manifests as decreased RV ejection fraction (RVEF), increased pulmonary circulation time, decreased pulmonary artery (PA) velocity
                                                  • Backward failure results in peripheral edema, hepatic congestion, ascites, pleural effusions
                                              • Most often due to either left heart failure (LHF) or pulmonary hypertension (PH)
                                              • Often results from PH resulting in maladaptive RV hypertrophy and later failure
                                                • Cor pulmonale = RV failure due to pulmonary parenchymal or vascular disease
                                                • Acute RHF may be seen with massive pulmonary emboli
                                              • RHF occurring without LHF is identified when abnormally high right atrial pressures are accompanied by normal capillary wedge pressures

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Echocardiographic Findings

                                                      • Angiographic Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Staging, Grading, & Classification

                                                                • Gross Pathologic & Surgical Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          Selected References

                                                                          1. Gorter TM et al: Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 20(1):16-37, 2018
                                                                          2. Yancy CW et al: 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Card Fail. 23(8):628-651, 2017
                                                                          3. Aschauer S et al: The right heart in heart failure with preserved ejection fraction: insights from cardiac magnetic resonance imaging and invasive haemodynamics. Eur J Heart Fail. 18(1):71-80, 2016
                                                                          4. Simon MA: Assessment and treatment of right ventricular failure. Nat Rev Cardiol. 10(4):204-18, 2013
                                                                          5. Mertens LL et al: Imaging the right ventricle--current state of the art. Nat Rev Cardiol. 7(10):551-63, 2010
                                                                          6. Braunwald E et al: Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia: W. B. Saunders. 454-472, 2015