What are the treatment options for right-sided heart failure (right ventricular failure)?

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 supportive therapies such as diuretics, digoxin, and lifestyle modifications, as recommended by the most recent guidelines 1. The management of right-sided heart failure involves a multifaceted approach, including:

• Diuretic therapy to control volume status and reduce fluid overload, with furosemide being a commonly used option 1
• Digoxin for added inotropic support in patients with chronic right-sided heart failure 1
• Lifestyle modifications, such as a low sodium diet (<2g daily), fluid restriction if necessary, regular moderate exercise as tolerated, and smoking cessation 1
• Oxygen therapy for patients with hypoxemia to prevent further strain on the right ventricle 1
• Consideration of specific therapies for pulmonary hypertension, such as sildenafil or bosentan, in patients with this underlying cause 1
• Individualized treatment based on the specific cause of right heart failure, severity of symptoms, and comorbidities 1

Key considerations in the treatment of right-sided heart failure include:

• The importance of addressing the underlying cause of the condition, whether it be primary cardiomyopathies, RV ischemia and infarction, or other factors 1
• The need for ongoing assessment and management of symptoms, including monitoring for signs of disease progression 1
• The role of supportive therapies in improving symptoms and quality of life, while also 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 summarized as follows:

• Medical Treatment: Medical treatment of RV failure should include optimizing preload, augmenting contractility with vasopressors and inotropes, and considering inhaled pulmonary vasodilators 2.
• Fluid Optimization: Patients with acute RHF may require fluid resuscitation or diuresis as they are preload dependent 3.
• Hemodynamic Support: Hypotension should be rapidly addressed with vasopressors, and cardiac contractility can be augmented with inotropes 3.
• Mechanical Circulatory Support: When medical therapies are insufficient, mechanical circulatory support (MCS) is needed to maintain systemic and RV perfusion, with extracorporeal membrane oxygenation (ECMO) being the most efficient and effective modality 2.
• Ventilation Support: Efforts should be made to support oxygenation while trying to avoid intubation if possible 3.
• Etiological or Specific Therapy: The therapeutic approach should start with the central pillar of etiological or specific therapy, extending to various aspects related to hemodynamic support, ventilation support, fluid optimization, and advanced resources such as right ventricular assist devices 4.
• Advanced Resources: Advanced resources such as right ventricular assist devices (e.g., ECMO, Impella RP, or ProtekDuo) may be necessary in some cases 4.
• Pharmacological Therapies: Novel pharmacological therapies such as macitentan and riociguat may be available for specific etiologies of RHF 5.
• Current Treatment Recommendations: Current treatment recommendations include mechanical circulatory support, and the latest research on RHF includes the molecular basis of RHF and potential novel treatment methods 5, 6.