Acute Right Heart Failure

Acute Right Heart Failure

Acute right heart failure (RHF) is a clinical syndrome in which the right ventricle (RV) cannot deliver sufficient blood forward into the pulmonary circulation, producing systemic venous congestion and reduced left‑sided filling and output. In the emergency department many causes are potentially reversible (for example massive pulmonary embolism or RV myocardial infarction), but deterioration can be rapid and fatal unless the precipitant is recognised and treated.

This section summarises definitions, salient pathophysiology, common causes, key clinical features, focused investigations, immediate ED management and escalation, with practical tips drawn from UK guidance (NICE CG187, NG158 and HTG guidance) and Resuscitation Council UK recommendations.

Definitions

• Right heart dysfunction: echocardiographic evidence of impaired RV contractility or abnormal RV pressures.
• Right heart failure (RHF): clinical syndrome of systemic venous congestion (raised JVP, peripheral oedema, hepatic congestion, ascites) with reduced forward flow from structural or functional RV impairment.

Pathophysiology - practical points for the ED

• RV physiology: the RV is thin‑walled and adapted for volume handling at low pressure. It tolerates volume overload better than sudden pressure increases. Acute rises in pulmonary vascular resistance (PVR) (for example, massive PE) are poorly tolerated.
• Cardiac output (CO) = heart rate × stroke volume. RV stroke volume is essential to fill the left heart and maintain systemic perfusion.
• Mechanisms of RV dysfunction:
• Impaired contractility:...