Acute Right Ventricular Failure Triggered by Excessive Fluid Resuscitation in Septic Shock

Acute right ventricular (RV) failure is a serious but underappreciated complication of septic shock resuscitation. Septic shock involves both relative hypovolemia and pathological vasoplegia [1, 2]. Fluid resuscitation is essential early, but excessive volumes can precipitate RV dilation, systolic dysfunction, and venous congestion before the problem is recognized. We report a 68-year-old postoperative patient who developed hemodynamic deterioration after 10 L of crystalloid for abdominal sepsis. Bedside echocardiography identified severe RV dilation with a D-sign, a TAPSE of 10 mm, and a plethoric noncollapsing inferior vena cava (IVC) of 28 mm. De-resuscitation with diuresis and vasopressors produced transient improvement, but the patient died 1 week later from recurrent sepsis due to an anastomotic leak. The case shows that fluid-induced RV failure can develop silently and may be reversible if caught early. Earlier echocardiographic monitoring might have allowed earlier recognition before hemodynamic collapse developed.