Right-sided heart failure: diagnosis and treatment strategies

Right ventricular (RV) dysfunction in the setting of cardiomyopathy, ischemia, and pulmonary hypertension is associated with high morbidity and mortality, but therapeutic clinical trials examining RV failure as a primary outcome are lacking. This review focuses on the ontologic, morphologic, and microscopic differences between the right and left ventricles. It also discusses the rationale and potential risks associated with the extrapolation of medical therapies used in left ventricular failure and pulmonary arterial hypertension management to the treatment of RV failure. Finally, it introduces the reader to new echocardiographic techniques that may be used to diagnose clinical and subclinical RV systolic and diastolic dysfunction. Given the anticipated rise in the prevalence of RV dysfunction, more studies are needed to gain a better understanding of RV cellular and subcellular function and its response to pathologic stressors and disease so that therapeutic targets can be devised to improve RV failure morbidity and mortality.