Future Challenges in Acute Right Heart FailureAuthor: Markus W. Ferrari
Physiologically, with every stroke right and left ventricle ejects the same blood volume. However, due to low resistance of the pulmonary circulation the stroke work is about 75% lower than on the left side resulting in a thinner right ventricular wall. Therefore, the right ventricle shows more compliance and less resistance to an abrupt increase in after load. Acute Right Heart Failure (ARHF) is a clinically complex situation occurring in 10 to 20% of all acute heart failure patients mostly due to right coronary occlusion or secondary pulmonary hypertension [1,2]. It is characterized by an inability of the right ventricle to generate enough cardiac output, thereby resulting in a volume deficit of the left ventricle. In addition, ARHF results in an increase in venous congestion and finally in cardiogenic shock. The prognosis of ARHF is extremely dismissal. Treatment of this life-threatening clinical condition primarily focuses on treating the cause of acute right ventricle failure. In addition, optimization of preload status by volume infusion, reduction of after load, improving contractility by adequate pharmacotherapy, and mechanical circulatory support may be beneficial for patients suffering from ARHF. Figure 1 summarizes the management of acute right heart failure. Since most studies have focused on improving left heart function so far, diagnosis and therapy of ARHF has been rarely in the center of research and innovative developments in medical technology. The right ventricle has therefore been named the “forgotten chamber”  (Figure 1).