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Right Ventricle Failure in Sepsis: A Case Report.
Umashankar Lakshmanadoss1, Bryana M Levitan2, David H Hsi2
1Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, MD, USA.
Cardiology Research
|March 29, 2017
Summary
Sepsis can cause heart muscle depression, affecting both the left and right ventricles (RV). Managing RV function in sepsis requires careful fluid therapy guided by central venous pressure (CVP) to optimize cardiac output.
Area of Science:
- Cardiology
- Critical Care Medicine
- Physiology
Background:
- Sepsis frequently leads to myocardial depression, primarily impacting the left ventricle (LV).
- The right ventricle (RV) can also be affected by sepsis, experiencing elevated pressure due to pulmonary vasoconstriction, resulting in RV dysfunction.
- The RV has a limited capacity to adapt to acute pressure overload compared to the LV.
Observation:
- Aggressive fluid resuscitation is crucial for maintaining RV function during sepsis.
- However, excessive hydration can lead to RV dilation, impair LV diastolic filling, and decrease overall cardiac output.
- Echocardiography is recommended for assessing RV function in patients with inadequate cardiac output post-resuscitation.
Findings:
- Fluid therapy guided by central venous pressure (CVP) measurements is essential when RV dysfunction is present.
- Increasing CVP may improve cardiac output if RV function is preserved.
- Conversely, rising CVP with declining cardiac output indicates worsening RV dysfunction and necessitates a revised fluid management strategy.
Implications:
- Optimizing fluid management based on RV function assessment and CVP monitoring is critical for improving outcomes in septic patients.
- Addressing reversible causes such as acidosis and hypoxia is paramount alongside fluid therapy.
- This approach highlights the importance of individualized hemodynamic management in sepsis-induced cardiomyopathy.
