Right ventricular dysfunction

Not in shock, right ventricular dysfunction absent o Manage as deep vein thrombosis (DVT) protocol... 

Not in shock and right ventricular dysfunction present o Manage as DVT protocol... 

Meyer T, Binder L, Hruska N, Luthe H, Buchwald AB. Cardiac troponin 1 elevation in acute pulmonary embohsm is associated with right ventricular dysfunction. J Am CoH Cardiol 2000 36 1632-6. 

McCann GP, Van Dockum WG, Beek AM, et al. Extent of MRI delayed enhancement of myocardial mass is related to right ventricular dysfunction in pulmonary artery hypertension. Am J Roentgenol 2007 188 349-55. 

In patients with pulmonary hypertension, calcium channel blocking drugs have been found to produce pulmonary artery dilation and therefore improvement in cardiac output and relief of hypoxia [233, 234]. Most of the studies have used short-term administration to carefully selected patients. Thus, the beneficial effects need to be confirmed in longer studies using more patients with advanced pulmonary hypertension. Detrimental deterioration in right ventricular performance has been found in some patients with severe right ventricular dysfunction following the administration of verapamil or nifedipine [233]. 

Anaphylactic reactions occur in 1% of patients with diabetes mellitus who have received protamine-containing insulin NPFl insulin or protamine zinc insulin) but are not limited to this group. A less common reaction consisting of pulmonary vasoconstriction, right ventricular dysfunction, systemic hypotension, and transient neutropenia also may occur after protamine administration. 

For candidate selection several factors have to be assessed low left ventricular (LV) ejection fraction, right ventricular dysfunction, the New York Heart Association (NYHA) functional class, ventricular arrhythmias, measurement of functional capacity with determination of maximal oxygen consumption, hemodynamic measurements, pulmonary capillary resistance and the neurohumoral activation resulting from congestive heart failure (elevated plasma norepinephrine levels) (Aaron-SON et al. 1997 Doval et al. 1996 Gradman and Deedwania 1994 MANCiNietal. 1991 Stevenson et al. 1990). 

Excess fluid administration may increase right-ventricular (RV) wall stress, RV ischemia, tricuspid regurgitation, and cause a septal shift that may impair left-ventricular (LV) compliance and filling. Administer with caution in patients with documented severe RV dysfunction or when measured pressures are high... 

Abstract Two thirds of the nearly half a million deaths per year in the United States due to sudden cardiac death (SCD) is attributed to coronary artery disease (CAD) and most commonly results from untreated ventricular tachyarrhythmias. Patients with ischemic cardiomyopathy and left ventricular dysfunction are at highest risk for SCD, but this still defines only a small subset of patients who will suffer SCD. Multiple lines of evidence now support the superiority of implantable cardioverter defibrillator (ICD) therapy over antiarrhythmic therapy for both primary and secondary prevention of SCD in advanced ischemic heart disease. Optimization of ICD therapy in advanced ischemic cardiomyopathy includes preventing right ventricular pacing as well as the use of highly effective anti-tachycardia pacing to reduce the number of shocks. While expensive, ICD therapy has been shown to compare favorably to the accepted standard of hemodialysis in cost effectiveness analyses. 

The IV administration of propafenone is accompanied by an increase in right atrial, pulmonary arterial, and pulmonary artery wedge pressures in addition to an increase in vascular resistance and a decrease in the cardiac index. A significant decrease in ejection fraction may be observed in patients with preexisting left ventricular dysfunction. In the absence of cardiac abnormalities, propafenone has no significant effects on cardiac function. 

Congestive heart failure (CHF) is a clinical syndrome with multiple causes and involve the right or left ventricle or both and in CHF, cardiac output is usually below the normal range. This ventricular dysfunction may be systolic, which leads to inadequate force generation to eject blood normally and diastolic, which leads to inadequate relaxation to permit normal filling. Systolic dysfunction, with decreased cardiac output and significantly reduced ejection fraction is typical of acute heart failure, especially that resulting from myocardial infarction. 

Anthracyclines can cause the late complication of a cardiomyopathy, which can be irreversible and can proceed to congestive cardiac failure, ventricular dysfunction, conduction disturbances, or dysrhythmias several months or years after the end of treatment (3,4). Doxorubicin can cause abnormalities of right ventricular wall motion (5). A significant number of patients receiving anthracyclines develop cardiac autonomic dysfunction (6). 

Factors that decrease theophylline clearance and lead to reduced maintenance-dose requirements include advanced age, bacterial or viral pneumonia, left or right ventricular failure, liver dysfunction, hypoxemia from acute decompensation, and use of drugs such as cimetidine, macrolides, and fluoroquinolone antibiotics. Factors that may enhance theophylline clearance and result in the need for higher maintenance doses include tobacco and marijuana smoking, hyperthyroidism, and the use of such drugs as phenytoin, phenobarbital, and rifampin. 

Echocardiography is a noninvasive tool that can provide assessment of possible causes, shunts, left atrial hypertension, left ventricular dysfunction, valvular heart disease, and consequences of pulmonary hypertension. Measurements of RV systolic and diastolic pressures, and associated findings of paradoxical septal motion, diminished IVC collapse, RVH, right atrial (RA) or right ventricular (RV) enlargement, pericardial effusion, and decreased RV ejection time should all be included in the assessment of these patients. The measurement of PA pressures can be done with relative precision and varying degrees of correlation with invasive measures. 

Figure 110.4 Relationships between T3 and left ventricular ejection fraction in patients with left ventricular dysfunction. Scatterplots showing the relationship between total T3 (TT3) and left ventricular ejection fraction (LVEF) in patients without (panel a) and with overt heart failure (panel b). Data from Pingitore etal., (2006) (left side) and from Pingitore etal., (2005) (right side).

---