Mechanisms of acute right ventricular dysfunction/failure (RVD/RVF) #rightventricle #rvfailure #rvdysfunction

$Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management Source:$

Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.1029 Graphic representation of echocardiographic parameters in the assessment of right ventricular dysfunction. Ao, aorta; DTI, Doppler tissue imaging; EF, ejection fraction; ET, ejection time; FAC, fractional area change; IVC, inferior vena cava; IVCT, isovolumic contraction time; IVRT, isovolumic relaxation time; LA, left atrium; LV, left ventricle; LVEDD, left ventricular end‐diastolic diameter; RA, right atrium; RIMP, right ventricular index of myocardial performance; RV, right ventricle; RVEDD, right ventricular end‐diastolic diameter; TAPSE, tricuspid annular plane systolic excursion; TR, tricuspid regurgitation. Reproduced from Harjola et al.99 with permission of the authors. #Diagnosis #Cardiology #Echocardiogram #RightSided #CongestiveHeartFailure #RVFailure #Criteria #Assessment #RVDysfunction #RightVentricular

Echocardiography Right ventricular function can be assessed using several methods and echocardiography is generally the first‐line tool (Figure 1). TAPSE is most frequently used and has an independent prognostic value in HFpEF.4, 8, 23-25 The currently recommended lower limit cut‐off for TAPSE is <17 mm,12 although prior studies frequently used <16 mm. Fractional area change (with a lower limit of normal <35%12) is also commonly used, and is predictive of all‐cause mortality and heart failure hospitalizations in HFpEF. #Diagnosis #Cardiology #POCUS #Echocardiogram #RightVentricle #RightVentricular #RVDysfunction #Measurements #Criteria

Relevant Sonopathology of the Parasternal Long Axis (PLAX) - Point of Care Ultrasound - Right Ventricular Hypertrophy - Right Ventricular Dilatation - Aortic Dissection - Aortic Stenosis - Diastolic Heart Failure - Aortic Aneurysm - Papillary Muscle Rupture - Left Ventricular Hypertrophy - Pericardial Effusion - Dilated Cardiomyopathy - Systolic Heart Failure Infographic by EMSPOCUS @emspocus #Diagnosis #POCUS #Echocardiogram #Parasternal #LongAxis #PLAX #Sonopathology

Kussmaul's sign in a patient with suspected pulmonary embolism - Dr. David Juurlink @DavidJuurlink Kussmaul sign is a paradoxical rise in jugular venous pressure (JVP) on inspiration, or a failure in the appropriate fall of the JVP with inspiration. It can be seen in some forms of heart disease and is usually indicative of limited right ventricular filling due to right heart dysfunction. #Kussmauls #Signs #PhysicalExam #Clinical #Video #Neck #JVP #Cardiology

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Approach to the Hypotensive Patient - Differential Diagnosis Framework for Hypotension Blood Pressure = Heart Rate x Stroke Volume x Peripheral Vascular Resistance Bradycardia (inadequate cardiac output): • Sinus bradycardia • AV blocks • Sick sinus syndrome Tachycardia (inadequate filling time): • Sinus tachycardia • Atrial tachycardias • Ventricular arrhythmia Decreased Preload: • Volume depletion • Pulmonary embolism • Pericardial tamponade • Tension pneumothorax • Right ventricular dysfunction • Vasodilatory meds • Adrenal insufficiency (MC) Cardiac Contractility: • Left ventricular dysfunction - Myocardial infarction - Free wall rupture - Myocarditis - Papillary muscle rupture • Acute mitral regurgitation • Aortic regurgitation • Aortic stenosis • Meds: negative inotropes Decreased Afterload: • Sepsis • Anaphylaxis • Adrenal insufficiency (GC) • Vasodilatory meds • Neurogenic #Hypotension #hypotensive #differential #diagnosis #causes #Hypotensive

Cardiac Findings in Sarcoidosis Most Commonly Affected Sites: - LV free wall (esp. basal posterior wall) - Interventricular septum. (esp. basal) LV Myocardial Involvement: - LV wall thickening - LV wall thinning - Focal hypokinesis or RWMA - LV Aneurysm - Global systolic dysfunction (+LVEF) - Reduced myocardial strain - Diastolic dysfunction - Papillary muscle involvement Valvular Abnormalities: - Mitral regurgitation due to primary thickening of leaflets - Mitral or tricuspid regurgitation secondary to ventricular dysfunction or pulmonary hypertension Pericardial involvement: - Effusion ECG Abnormalities: - Advanced atrioventricular block - Ventricular arrythmias (V. tachycardia, multifocal) - Right bundle branch block - Axis deviation - Abnormal a-wave #Cardiac #Findings #Sarcoidosis #Cardiology #Involvement #diagnosis

Echocardiographic Findings of Acute Right Ventricular Strain - Increased RV:LV Size Ratio - Abnormal Septal Motion - McConnell's Sign - Tricuspid Regurgitation - Elevated Pulmonary Artery Systolic Pressure - Decreased TAPSE - Decreased S' - Mid-Systolic Notching - 60/60 Sign - Speckle Tracking: Decreased Free Wall Strain Dr. Kazi Ferdous @fazalabul #RV #Strain #Echocardiogram #POCUS #diagnosis #Right #Ventricular #cardiology #POCUS

Acute and long-term complications of acute STEMI Acute and long-term complications of acute myocardial infarction are summarized in Figure 3 (below). Ventricular tachycardia and ventricular fibrillation may occur any time after the coronary artery is occluded. These arrhythmias, which are due to ischemia, are particularly common during the first few hours after artery occlusion. They cause the vast majority of deaths in the acute phase. The risk then rapidly abates within 6 hours. However, myocardial infarction (particularly if extensive and in presence of heart failure) may result in chronic remodeling of the myocardium; such remodeling can cause ventricular tachycardia and ventricular fibrillation. The most common mechanical complication of acute STEMI (and myocardial infarction in general) is papillary muscle rupture. Wall rupture (septum or left ventricular free wall) is less common. Ischemic bradyarrhythmia (bradycardia) is also common, especially with inferior infarctions. #Diagnosis #Cardiology #Timeline #Timetable #PostMI #Complications #Myocardial #Infarction #Early #Late