MDCAST: Right Heart Failure: The Hidden Critical Care Problem

About this episode

This episode discusses the vulnerabilities of the right ventricle in acute right heart failure and its implications in critically ill patients.

This episode is an overview of acute right heart failure , with a strong emphasis on why the right ventricle is so vulnerable and why clinicians often miss its role in critically ill patients. Dr. Mike Lauria explains that, unlike the left ventricle, the RV is designed to pump against a low-pressure, high-compliance pulmonary circulation. That makes it especially sensitive to sudden increases in afterload, whether from pulmonary embolism, pulmonary hypertension, ARDS, sepsis, or other cardiopulmonary stressors. The result is that RV dysfunction can develop quickly and become a major driver of shock in transport, emergency, and ICU patients. A major theme of the episode is the “RV spiral of death” : as RV afterload rises, the right ventricle dilates, pumps less effectively, and begins to impair left ventricular filling by bowing into the septum. This lowers cardiac output, worsens systemic perfusion, and reduces blood flow to the RV itself, which further weakens the ventricle and accelerates hemodynamic collapse. The transcript also reviews practical clues that can help identify RV failure, especially in transport, including CT evidence of an enlarged RV, bedside echo findings…

People in this episode

Guest: Dr. Mike Lauria

Topics covered

• right heart failure
• critical care
• RV dysfunction
• pulmonary circulation
• hemodynamic collapse
• resuscitation framework

Keywords

• right heart failure
• RV dysfunction
• pulmonary embolism
• sepsis
• cardiac output
• TAPSE
• tricuspid regurgitation
• hemodynamic collapse

Mentioned in this episode

Organizations: FlightBridgeED

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