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Morning Report

Morning Report. Anne Lachiewicz April 5, 2010. Diagnostic signs. Kussmaul’s sign - JVP increases with respiration instead of declines - Reflects an increase in right atrial pressures (R-sided HF) Hepatojugular reflux

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Morning Report

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  1. Morning Report Anne Lachiewicz April 5, 2010

  2. Diagnostic signs Kussmaul’s sign - JVP increases with respiration instead of declines - Reflects an increase in right atrial pressures (R-sided HF) Hepatojugular reflux - Distension of the JV induced by applying manual pressure over the liver. - Reflects elevated PCWP (L-sided HF)

  3. Causes of Right Ventricular Failure

  4. Clinical evaluation Fatigue, lethargy, dyspnea, early satiety Elevated JVP TR w/ murmur Kussmaul’s sign Right-sided S3 gallop Peripheral cyanosis & edema Hepatomegaly & ascites Elevated Cr, lactate, BNP, troponin, transaminases & bilirubin Decreased Na & HCO3 NO PND or orthopnea

  5. Normal pulmonary pressures Pulmonary hypertension

  6. Effect of increased afterload/PAP on the RV

  7. Treatment/Prognosis No specific therapies for chronic RV failure – identify & correct the underlying physiologic derangements (e.g. Tx L-sided HD). Appropriate diuresis may decrease RV loading w/o negatively impacting LV preload & cardiac output. In pts with chronic L-sided HF, RV dysfunction is an independent predictor of reduced exercise capacity & survival.

  8. References • Brieke, A. and DeNofrio, D. Right ventricular dysfunction in chronic dilated cardiomyopathy and heart failure. • Mahmud, M. and Champion, H. Right ventricular failure complicating heart failure: pathophysiology, significance, and management strategies. Current cardiology reports, 2007:200-208. • Matthews, J. and McLaughlin V. Acute right ventricular failure in the setting of acute pulmonary embolism or chronic pulmonary hypertension: a detailed review of the pathophysiology, diagnosis, and management. Current cardiology Reviews, 2008:49-59. • McDonald, M. and Ross, H. Trying to succeed when the right ventricle fails. Current opinions in cardiology, 2009:239-245.

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