The right ventricle: physiologic and pathophysiologic considerations

The right ventricle (RV) is responsible for accepting venous blood and propelling it to the lungs where it is oxygenated and its CO2 eliminated. Under normal conditions, at rest and during exercise, the pressure required by the RV to maintain the cardiac output (CO) is modest. The functional significance of the RV in sustaining circulatory homeostasis, therefore, appears to be minimal. However, whenever pulmonary vascular resistance (PVR) is elevated (e.g., left heart failure or pulmonary vascular disease) or whenever venous return is reduced (e.g., hypovolemia, increased pleural pressure), the necessity of this pulsatile pump is without question. As a muscular pump, the thin-walled RV is not unlike the left ventricle (LV) except that during diastole it is twice as distensible as the LV and during systole its stroke volume is twice as sensitive to the level of ejection pressure. However, under conditions of chronic pressure overload, the RV will hypertrophy and become capable of generating systemic levels of pressure. This is particularly necessary during physical activity in patients with pulmonary vascular disease. Thus, the RV is an integral component of the body's gas transport system and its contribution to sustaining circulatory homeostasis is without question.