Right Heart Failure in Pulmonary Hypertension

Right heart failure is a major cause of morbidity and mortality in pulmonary hypertension. Its pathophysiology is complex and involves both adaptive and maladaptive patterns of right ventricular change. In addition to the gold standard of right heart catheterization, noninvasive imaging such as echocardiography is useful in diagnosis and risk assessment. Management focuses on optimizing preload, reducing afterload, and supporting the function of the right ventricle with vasopressors and inotropes, if necessary. If required, mechanical support is increasingly used to facilitate recovery or as a bridge to transplant.