الفهرس 
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Abstract
Summary
ulmonary arterial hypertension continues to cause
significant morbidity and mortality. Although the right
ventricle can adapt to an increase in after-load, progression of
the pulmonary vasculopathy that characterize pulmonary
arterial hypertension, causes many patients to develop
progressive right ventricular failure. Right ventricular failure
represents a high percent of cases admitted to ICU and its
treatment represents a challenge to physicians.
Acute right ventricular failure develop from disorders
that lead to pressure overload, volume overload, intrinsic
myocardial disease, or pericardial constrain. Immediate clinical
and diagnostic evaluation and care is required in order to select
the type of treatment. Initial diagnostic assessment should
include clinical examination supported by the patient’s history,
ECG, chest X-ray, plasma BNP/nt-proBNP, biomarkers of
myocardial injury and other ordinary laboratory tests.
Echocardiography should be performed in all patients as soon
as possible to provide diagnostic and prognostic information in
patients with pulmonary hypertension.
Cardiac magnetic resonance imaging provides a direct
evaluation of RV size, morphology and function. Also Swan-
Ganze catheter, right heart catheterization, abdominal ultrasound
scan, pulmonary function tests and arterial blood gases are done.
Acute pulmonary embolism is a frequent cause of RVF and
diagnostic CT-angiography is often required.
P
Summary
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Fluid management and optimization of preload in these
patients is difficult. Minimize fluid retention and diuretic therapy
is often used. Most important interventions to reverse RV failure
are to reduce RV after load by using of pulmonary vasodilators.
Patients with PAH may benefit from phosphodiestrase inhibitors
as sildenafil citrate as inotropic agent. Prostacycline derivatives
are the initial treatment of choice in these patients. Inhaled nitric
oxide is selective pulmonary vasodilator.
Maintenance of cardiac rhythm and using anti-arrhythmic
drugs or even cardio-version are very important. Anticoagulant
therapy is used if the risk of thrombo-embolic events in RV
failure. Supplement oxygen and ventilation to keep peripheral
oxygen saturation above 90% and correction of anemia if
present.
Despite advances in medical therapy, lung or heart-lung
transplantation remains an important treatment option for patients
with progressive pulmonary hypertension with refractory RV
failure.
A lot of complications occur with pulmonary hypertension
and RV failure leading to sudden cardiac death such as
arrhythmia, left main Coronary artery compression syndrome,
dissection and Rupture of pulmonary artery, hemoptysis and
syncope. Hepatic cirrhosis, renal failure, and multi organs failure
are also fatal complication.