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Right ventricular dysfunction after acute pulmonary embolism: pathophysiologic factors, detection, and therapeutic
1Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
American Heart Journal
|December 1, 1995
Summary
Acute pulmonary embolism (PE) can cause right heart failure, impacting cardiac output. Identifying right ventricular dysfunction is crucial for risk stratification and guides aggressive treatment for better outcomes.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Critical Care Medicine
Background:
- Acute pulmonary embolism (PE) can lead to significant right ventricular (RV) strain.
- RV dysfunction compromises cardiac output and systemic circulation via ventricular interdependence.
- Ischemia and RV infarction can result from decreased coronary perfusion pressure in the overloaded RV.
Purpose of the Study:
- To highlight the clinical significance of right ventricular dysfunction in acute PE.
- To emphasize the need for expanded definition of hemodynamic instability in PE.
- To underscore the prognostic value of detecting RV dysfunction.
Main Methods:
- Review of clinical findings, hemodynamic values, and echocardiographic signs.
- Analysis of patient risk stratification based on RV function.
- Evaluation of treatment strategies for RV dysfunction post-PE.
Main Results:
- Echocardiography is key in identifying RV dysfunction (dilatation, hypokinesis).
- RV dysfunction is associated with a worse prognosis in acute PE patients.
- Hemodynamic instability should encompass RV dilatation and wall motion abnormalities, even in normotensive patients.
Conclusions:
- Early detection of RV dysfunction in acute PE is critical for risk assessment.
- Aggressive interventions like thrombolysis or embolectomy can improve RV function and outcomes.
- The definition of hemodynamic instability in PE requires broadening to include RV abnormalities.