From the Guidelines
Treatment for right-sided heart failure should prioritize addressing the underlying cause, managing symptoms, and preventing disease progression, with a focus on diuretics, lifestyle modifications, and selective use of pulmonary vasodilators and inotropic support, as recommended by the most recent guidelines 1. The management of right-sided heart failure involves a multifaceted approach, including:
- Diuretics, such as furosemide, to reduce fluid overload and improve symptoms of peripheral edema and ascites 2
- Lifestyle modifications, including sodium restriction (<2g daily), fluid restriction if hyponatremia is present, regular moderate exercise as tolerated, and smoking cessation 3
- Pulmonary vasodilators, such as sildenafil or bosentan, for patients with pulmonary hypertension causing right heart failure 3
- Inotropic support with dobutamine or milrinone in advanced cases 2
- Supplemental oxygen therapy for patients with hypoxemia to prevent further strain on the right ventricle 2 Key considerations in the treatment of right-sided heart failure include:
- Addressing the underlying cause of the condition, such as primary cardiomyopathies, RV ischemia and infarction, or pulmonary hypertension 1
- Optimizing preload and reducing right ventricular workload 1
- Enhancing contractility and improving cardiac function 1
- Preventing disease progression and reducing morbidity and mortality 1
From the FDA Drug Label
Milrinone Lactate Injection is indicated for the short-term intravenous treatment of patients with acute decompensated heart failure. The treatment options for right-sided heart failure (right ventricular failure) are not explicitly stated in the provided drug label.
- Intravenous milrinone lactate may be considered for the short-term treatment of acute decompensated heart failure, but its use specifically for right-sided heart failure is not directly mentioned. The FDA drug label does not answer the question.
From the Research
Treatment Options for Right-Sided Heart Failure
The treatment options for right-sided heart failure (right ventricular failure) can be categorized into several approaches:
- Medical therapies, including optimizing volume status, hemodynamic and pharmacologic support, and rhythm control 4
- Mechanical therapies, such as venoarterial extracorporeal oxygenation and right ventricular assist devices, both surgical and percutaneous 4
- Management strategies, including treating the underlying condition, optimizing oxygenation and ventilation, treating arrhythmias, and understanding the patient's hemodynamics with bedside ultrasound 5
- Supportive care, such as fluid resuscitation or diuresis, vasopressors for hypotension, and inotropes to augment cardiac contractility 5, 6
Advanced Therapies
Advanced therapies for right-sided heart failure include:
- Extracorporeal membrane oxygenation (ECMO), which can provide indirect support to the right ventricle by reducing preload, reducing right ventricular wall tension, and delivering oxygenated blood to the coronary circulation 6, 7
- Right ventricular assist devices, such as Impella RP or ProtekDuo, which can provide mechanical support to the right ventricle 7
- Inhaled pulmonary vasodilators, which can help reduce pulmonary vascular resistance and improve right ventricular function 6, 8
Five Pillars of Acute Right Ventricular Heart Failure Therapy
The five pillars of acute right ventricular heart failure therapy include:
- Etiological or specific therapy
- Hemodynamic support
- Ventilation support
- Fluid optimization
- Advanced resources, such as right ventricular assist devices or ECMO 7