What are the rare causes of acute right-sided heart failure?

From the Guidelines

Rare causes of acute right-sided heart failure include pulmonary embolism, right ventricular infarction, cardiac tamponade, and acute respiratory distress syndrome (ARDS), which can rapidly progress to cardiogenic shock and death if not addressed quickly. These conditions can suddenly increase pulmonary vascular resistance, directly impair right ventricular contractility, restrict cardiac filling and output, or cause hypoxemia and increased pulmonary vascular resistance through inflammatory lung injury 1. Other uncommon causes include air embolism, fat embolism syndrome, sepsis with myocardial depression, acute pulmonary hypertension from drugs or toxins, and arrhythmogenic right ventricular dysplasia. Management depends on the underlying cause but generally includes oxygen therapy, careful fluid management, vasopressors if needed, and specific interventions like thrombolytics for pulmonary embolism or pericardiocentesis for tamponade.

Some key points to consider in the management of right-sided heart failure include:

• The importance of prompt recognition and treatment of underlying causes to prevent progression to cardiogenic shock and death 1
• The need for careful fluid management and oxygen therapy to support right ventricular function and prevent further injury
• The potential for arrhythmias and other complications to contribute to the development of heart failure in patients with adult congenital heart disease (ACHD) 1
• The importance of considering the unique anatomy and physiology of patients with ACHD when evaluating and managing right-sided heart failure.

In terms of specific management strategies, the use of thrombolytics for pulmonary embolism and pericardiocentesis for tamponade can be lifesaving, and should be considered promptly in patients with these conditions 1. Additionally, careful fluid management and oxygen therapy can help support right ventricular function and prevent further injury, and should be tailored to the individual patient's needs and underlying condition. Overall, a comprehensive and multidisciplinary approach to the evaluation and management of right-sided heart failure is essential to optimize outcomes and reduce morbidity and mortality.

From the Research

Rare Causes of Acute Right Sided Heart Failure

• Cardiac tamponade is a rare cause of acute right sided heart failure, characterized by the accumulation of pericardial fluid, blood, pus, or air in the pericardium, leading to haemodynamic compromise and circulatory shock 2, 3.
• The main causes of cardiac tamponade include percutaneous cardiac interventions, malignancies, infectious/inflammatory causes, mechanical complications of myocardial infarction, and aortic dissection 3.
• Other rare causes of acute right sided heart failure include massive pulmonary embolism and chronic pulmonary hypertension, which can disrupt the normal physiology of the right ventricle 4.

Diagnosis and Management

• The diagnosis of cardiac tamponade is a clinical diagnosis based on a suggestive history and clinical presentation, and should be confirmed by echocardiography 2, 3.
• Pericardiocentesis is an interventional technique to drain pericardial fluid by a percutaneous route, and is the preferred treatment for cardiac tamponade 2, 3.
• Medical management of acute right heart failure is tailored to the different causative pathologies, and may include volume optimization, hemodynamic targets, and rhythm management 5, 4.
• Mechanical circulatory support can be utilized in cases of severe or end-stage dysfunction 5, 4.

Clinical Signs and Symptoms

• Clinical signs and symptoms of cardiac tamponade include hypotension, increased jugular venous pressure, and distant heart sounds (Beck triad) 2.
• Patients with cardiac tamponade may also experience dyspnoea, orthopnoea, weakness, fatigue, tachycardia, and oliguria 2.
• Clinical signs and symptoms of acute right heart failure may include worsening dyspnoea, distended jugular veins, and pulsus paradoxus 3, 4.