Treatment for right-sided heart failure?

From the Guidelines

Right-sided heart failure treatment should focus on addressing the underlying cause and managing symptoms.

Treatment Approaches

• The treatment of right-sided heart failure (RHF) involves a multifaceted approach, including medical management, surgical interventions, and mechanical circulatory support (MCS) devices 1.
• Medical management of RHF typically involves the use of diuretics to reduce fluid overload, vasodilators to decrease pulmonary vascular resistance, and inotropes to support right ventricular function 1.
• Surgical interventions, such as valve repair or replacement, may be necessary to address underlying structural abnormalities contributing to RHF 1.
• MCS devices, including durable and temporary devices, can provide support for patients with acute or chronic RHF, improving outcomes and enhancing quality of life 1.

Key Considerations

• The pathophysiology of RVD and the epidemiology and prognosis of RHF should be carefully considered when developing a treatment plan 1.
• Assessment and evaluation of RV function are crucial in diagnosing and managing RHF, and may involve the use of advanced imaging techniques and biomarkers 1.
• Evidence-based guidance should be used to inform treatment decisions, and clinicians should stay up-to-date with the latest research and recommendations from organizations such as the American Heart Association (AHA) 1.

From the Research

Treatment Options for Right-Sided Heart Failure

The treatment of right-sided heart failure is complex and requires a comprehensive approach. According to 2, treatment options continue to evolve rapidly, with multiple pharmacotherapies and mechanical circulatory support devices available.

• Pharmacotherapies:
  • Diuretic therapy to reduce fluid overload 3, 4
  • Vasodilator therapy to reduce afterload 3, 4
  • Inotropic therapy to augment cardiac contractility 3, 4
• Mechanical circulatory support devices:
  • Right-ventricular assist devices (RVADs) to support the failing right ventricle 4, 5
  • Catheter-based therapies to stabilize the critically ill patient and allow for right ventricular recovery 5

Management Strategies

Management of right-sided heart failure focuses on treating the underlying condition, optimizing oxygenation and ventilation, and understanding the patient's hemodynamics.

• Optimizing oxygenation and ventilation:
  • Efforts to support oxygenation while trying to avoid intubation if possible 3
• Hemodynamic management:
  • Fluid resuscitation or diuresis to optimize preload 3
  • Vasopressors to rapidly address hypotension 3
  • Inotropes to augment cardiac contractility 3

Emerging Therapies

Emerging therapies, such as left-to-right shunting, have shown potential in reducing left atrial hypertension and improving heart failure symptoms and outcomes. However, more research is needed to fully understand the effects of this therapy 6.