Skip to main content
SpringerLink
Log in

Acute Right Ventricular Dysfunction: Focus on Acute Cor Pulmonale

  • Chapter
Pulmonary Hypertension

Part of the book series: Contemporary Cardiology™ ((CONCARD))

  • 1613 Accesses

Abstract

Acute right heart failure related to pulmonary causes (acute cor pulmonale) is caused mainly by acute pulmonary embolism or acute respiratory distress syndrome (ARDS) requiring mechanical ventilatory support. The echocardiogram is even more useful than right heart catheterization in this situation, because the pulmonary arterial pressure correlates poorly with right ventricular function and cardiac output measurements are often unreliable. The echo also gives information not only on the extent of right ventricular dysfunction and dilation, but also on left ventricular filling and function. Acute cor pulmonale due to massive pulmonary embolism occurs in the majority of pulmonary embolism patients admitted to the ICU and may respond rapidly to thrombolytic therapy. Acute cor pulmonale in patients with ARDS is partly related to positive pressure ventilation and its effect on increasing the impedance of the pulmonary vasculature. Lung-protective ventilatory strategies using limited tidal volumes and plateau pressures can greatly lower the occurrence of acute cor pulmonale in ARDS patients. The therapy for acute cor pulmonale aims at minimizing the pulmonary vascular resistance and optimizing fluid volume. Vasopressor agents should be used in hypotensive patients to maintain coronary perfusion, but inhaled vasodilator agents like inhaled nitric oxide and prostacyclin are seeing increasing use in critical care settings to selectively dilate the pulmonary arterial bed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Cohn JN, Guiha NH, Broder MI, Limas CJ. Right ventricular infarction. Clinical and hemodynamic features. Am J Cardiol 1974; 33:209–14.

    Article  PubMed  CAS  Google Scholar 

  2. McFalls EO, Jan van Suylen R. Myocarditis as a cause of primary right ventricular failure. Chest 1993; 103:1607–8.

    Article  PubMed  CAS  Google Scholar 

  3. Kimchi A, Ellrodt GA, Berman DS, Riedinger M, Riedinger MS, Swan HJC, Murata GH. Right ventricular performance in septic shock: A combined radionuclide and hemodynamic study. J Am Coll Cardiol 1984; 4:945–51.

    PubMed  CAS  Google Scholar 

  4. Jardin F, Dubourg O, Bourdarias JP. Echocardiographic pattern of acute cor pulmonale. Chest 1997; 111:209–17.

    Article  PubMed  CAS  Google Scholar 

  5. Brooks H, Kirk E, Vokonas P, Urschel C, Sonnenblick E. Performance of the right ventricle under stress: Relation to right coronary flow. J Clin Invest 1971; 50:2176–83.

    Article  PubMed  CAS  Google Scholar 

  6. Redington AN, Gray JJ, Hodson ME, Rigby ML, Oldershaw PJ. Characterization of the normal right ventricular pressure-volume relation by biplane angiography and simultaneous micromanometer pressure measurements. Br Heart J 1988; 59:23–30.

    Article  PubMed  CAS  Google Scholar 

  7. Laks M, Gardner D, Swan JHC. Volumes and compliance measured simultaneously in the right and left ventricle of the dogs. Circ Res 1967; 66:612.

    Google Scholar 

  8. Hess DS, Bache RJ. Transmural right ventricular myocardial blood flow during systole in the awake dog. Circ Res 1979; 45:88–94.

    PubMed  CAS  Google Scholar 

  9. Vlahakes GJ, Turley K, Hoffman J. The pathophysiology of failure in acute right ventricular hypertension: Hemodynamic and biochemical correlations. Circulation 1981; 63:87–95.

    PubMed  CAS  Google Scholar 

  10. Guyton A, Lindsey A, Gilluly J. The limits of right ventricular compensation following acute increase in pulmonary circulatory resistance. Circ Res 1954; 11:326–32.

    Google Scholar 

  11. Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F. Hemodynamic instability in sepsis. Bedside assessment by Doppler echocardiography. Am J Respir Crit Care Med 2003; 168:1270–6.

    Article  PubMed  Google Scholar 

  12. Testa AG. Delle Malattie del Cuore. Milano, 1831.

    Google Scholar 

  13. McGinn S, White P. Acute cor pulmonale resulting from pulmonary embolism. JAMA 1935; 104:1473–8.

    Google Scholar 

  14. Vieillard-Baron A, Page B, Augarde R, Prin S, Qanadli S, Beauchet A, Dubourg O, Jardin F. Acute cor pulmonale in massive pulmonary embolism: Incidence, echocardiographic pattern, clinical implications and recovery rate. Intens Care Med 2001; 27:1481–6.

    Article  CAS  Google Scholar 

  15. Vieillard-Baron A, Schmitt JM, Augarde R, Fellahi JL, Prin S, Page B, Beauchet A, Jardin F. Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: Incidence, clinical implications, and prognosis. Crit Care Med 2001; 29:1551–5.

    Article  PubMed  CAS  Google Scholar 

  16. Elzinga G, Pienne H, De Jong J. Left and right ventricular pump function and consequences of having two pumps in one heart. A study on isolated cat heart. Circ Res 1980; 46:564–74.

    PubMed  CAS  Google Scholar 

  17. Jardin F, Farcot JC, Boisante L, Curien N, Margairaz A, Bourdarias JP. Influence of positive end-expiratory pressure on left ventricular performance. N Engl J Med 1981; 304:387–92.

    PubMed  CAS  Google Scholar 

  18. Jardin F, Dubourg O, Gueret P, Delorme G, Bourdarias JP. Quantitative two-dimensional echocardiography in massive pulmonary embolism: Emphasis on ventricular interdependence and leftward septal displacement. J Am Coll Cardiol 1987; 10:1201–6.

    Article  PubMed  CAS  Google Scholar 

  19. Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F. Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med 2002; 166: 1310–9.

    Article  PubMed  Google Scholar 

  20. Jardin F, Vieillard-Baron A. Right ventricular function and positive pressure ventilation in clinical practice: From hemodynamic subsets to respirator settings. Intens Care Med 2003; 29:1426–34.

    Google Scholar 

  21. Cigarroa R, Lange R, Williams R, et al. Underestimation of cardiac output by thermodilution in patients with tricuspid regurgitation. Am J Med 1989; 86:417–20.

    Article  PubMed  CAS  Google Scholar 

  22. Monchi M, Bellenfant F, Cariou A, Joly LM, Thebert D, Laurent I, Dhainaut JF, Brunet F. Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med 1998; 158:1076–81.

    PubMed  CAS  Google Scholar 

  23. Cournand A, Motley M, Werko L, Richard D. Physiological studies on the effects of intermittent positive pressure breathing on cardiac output in man. Am J Physiol 1948; 152:162.

    PubMed  CAS  Google Scholar 

  24. Scharf S, Brown R, Saunders N, Green L. Hemodynamic effects of positive pressure inflation. J Appl Physiol 1980; 49:124.

    PubMed  CAS  Google Scholar 

  25. Whittenberger J, McGregor M, Berglund E, Borst H. Influence of state of inflation of the lung on pulmonary vascular resistance. J Appl Physiol 1960; 15:878–82.

    PubMed  CAS  Google Scholar 

  26. Permutt S, Bromberger-Barnea B, Bane HN. Alveolar pressure, pulmonary venous pressure, and the vascular waterfall. Med Thorac 1962; 19:239–60.

    PubMed  CAS  Google Scholar 

  27. Jardin F, Brun-Ney D, Cazaux P, Dubourg O, Hardy A, Bourdarias JP. Relation between transpulmonary pressure and right ventricular isovolumetric pressure change during respiratory support. Cathet Cardiovasc Diag 1989; 16:215–20.

    Article  CAS  Google Scholar 

  28. Vieillard-Baron A, Loubières Y, Schmitt JM, Page B, Dubourg O, Jardin F. Cyclic changes in right ventricular output impedance during mechanical ventilation. J Appl Physiol 1999; 87:1644–50.

    PubMed  CAS  Google Scholar 

  29. Parker M, McCarty K, Ognibene F, Parillo J. Right ventricular dysfunction, similar to left ventricular changes, characterizes the cardiac depression of septic shock in humans. Chest 1990; 97:126–31.

    Article  PubMed  CAS  Google Scholar 

  30. Kasper W, Meinertz T, Kersting F, Lollgen H, Limbourg P, Just H. Echocardiography in assessing acute pulmonary hypertension due to pulmonary embolism. Am J Cardiol 1980; 45:567–72.

    Article  PubMed  CAS  Google Scholar 

  31. Mansencal N, Joseph T, Vieillard-Baron A, Qanadli S, Jondeau G, Lacombe P, Jardin F, Dubourg O. Comparison of different echocardiographic indexes secondary to right ventricular obstruction in acute pulmonary embolism. Am J Cardiol 2003; 92:116–9.

    Article  PubMed  Google Scholar 

  32. Valtier B, Dubourg O, Jondeau G, De Lassence A, Loubières Y, Dib JC, et al. Left and right intracardiac Doppler blood flow analysis in patients with severe acute pulmonary embolism. Eur Heart J 1993; 13 (Suppl):12.

    Google Scholar 

  33. Vieillard-Baron A, Qanadli S, Antakly Y, Fourme T, Loubières Y, Jardin F, Dubourg O. Transesophageal echocardiography for the diagnosis of pulmonary embolism with acute cor pulmonale: A comparison with radiological procedures. Intens Care Med 1998; 24:429–33.

    Article  CAS  Google Scholar 

  34. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: Clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353:1386–9.

    Article  PubMed  CAS  Google Scholar 

  35. Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser K, Rauber K, Iversen S, Redecker M, Kienast J, Just H, Kasper W. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: Results of a multicenter registry. Circulation 1997; 96:882–8.

    PubMed  CAS  Google Scholar 

  36. Zapol W, Snider M. Pulmonary hypertension in severe acute respiratory failure. N Engl J Med 1977; 296:476–80.

    PubMed  CAS  Google Scholar 

  37. Moloney ED, Evans TW. Pathophysiology and pharmacological treatment of pulmonary hypertension in acute respiratory distress syndrome. Eur Respir J 2003; 21:720–7.

    Article  PubMed  CAS  Google Scholar 

  38. Jardin F, Gueret P, Dubourg O, Farcot JC, Margairaz A, Bourdarias JP. Two-dimensional echocardiographic evaluation of right ventricular size and contractility in acute respiratory failure. Crit Care Med 1985; 13:952–6.

    PubMed  CAS  Google Scholar 

  39. Viitanen A, Salmenpera M, Heinonen J. Right ventricular response to hypercarbia after cardiac surgery. Anesthesiology 1990; 73:393–400.

    Article  PubMed  CAS  Google Scholar 

  40. Carvalho C, Barbas C, Medeiros D, Magaldi RB, Lorenzi Filho G, Kairalla RA, Deheinzelin D, Munhoz C, Kaufmann M, Ferreira M, Takagaki TY, Amato MB. Temporal hemodynamic effects of permissive hypercapnia associated with ideal PEEP in ARDS. Am J Respir Crit Care Med 1997; 156:1458–66.

    PubMed  CAS  Google Scholar 

  41. Prin S, Chergui K, Augarde, R, Page B, Jardin F. Ability and safety of a heated humidifier to control hypercapnic acidosis in severe ARDS. Intens Care Med 2002; 28:1756–60.

    Article  Google Scholar 

  42. Pruszczyk P, Torbicki A, Kuch-Wocial A, Chlebus M, Miskiewicz C, Jedrusik P. Transesophageal echocardiography for definition diagnosis of hemodynamically significant pulmonary embolism. Eur Heart J 1995; 16:534–8.

    PubMed  CAS  Google Scholar 

  43. Vieillard-Baron A, Jardin F. Why protect the right ventricle in patients with acute respiratory distress syndrome? Curr Opin CritCare 2003; 9:15–21.

    Article  Google Scholar 

  44. Schneider A, Teule G, Groeneveld A, Nauta J, Heidendal G, Thijs L. Biventricular performance during volume loading in patients with early septic shock, with emphasis on the right ventricle: A combined hemodynamic and radionuclide study. Am Heart J 1988; 116:103–12.

    Article  PubMed  CAS  Google Scholar 

  45. Vieillard-Baron A, Chergui K, Rabiller A, Peyrouset O, Page B, Beauchet A, Jardin F. Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intens Care Med 2004 Sep; 30(9):1734–9.

    Google Scholar 

  46. Angle MR, Molloy DW, Penner B, Jones D, Prewitt RM. The cardiopulmonary and renal effects of norepinephrine in cnine pulmonary embolism. Chest 1989; 95:1333–7.

    Article  PubMed  CAS  Google Scholar 

  47. Mebazza A, Karpati P, Renaud E, Algotsson L. Acute right ventricular failure—From pathophysiology to new treatments. Intens Care Med 2003; 30:185–96.

    Article  Google Scholar 

  48. Unverferth DA, Blanford M, Kates RE, Leier CV. Tolerance to dobutamine after a 72 hour continuous infusion. Am J Med 1980; 69:262–6.

    Article  PubMed  CAS  Google Scholar 

  49. Bhorade S, Christenson J, O’Connor M, Lavoie A, Pohlman A, Hall JB. Response to inhaled nitric oxide in patients with acute right heart syndrome. Am J Respir Crit Care Med 1999; 159:571–9.

    PubMed  CAS  Google Scholar 

  50. Christenson J, Lavoie A, O’Connor M, Bhorade S, Pohlman A, Hall JB. The incidence and pathogenesis of cardiopulmonary deterioration after abrupt withdrawal of inhaled nitric oxide. Am J Respir Crit Care Med 2000; 161:1443–9.

    PubMed  CAS  Google Scholar 

  51. Bradford KK, Deb B, Pearl RG. Combination therapy with inhaled nitric oxide and intravenous dobutamine during pulmonary hypertension in the rabbit. J Cardiovasc Pharmacol 2000; 36:146–51.

    Article  PubMed  CAS  Google Scholar 

  52. Lowson SM, Doctor A, Walsh BK, Doorley PA. Inhaled prostacyclin for the treatment of pulmonary hypertension after cardiac surgery. Crit Care Med 2002; 30:2762–4.

    Article  PubMed  CAS  Google Scholar 

  53. Langer F, Wendler O, Wilhelm W, Tscholl D, Schafers HJ. Treatment of a case of acute right heart failure by inhalation of iloprost, a long-acting prostacyclin analogue. Eur J Anaesthesiol 2001; 18:770–3.

    Article  PubMed  CAS  Google Scholar 

  54. Ukkonen H, Saraste M, Akkila J, et al. Myocardial efficiency during levosimendan infusion in congestive heart failure. Clin Pharmacol Ther 2000; 68:522–31.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Antoine Vieillard-Baron
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. François Jardin
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Division of Pulmonary, Critical Care and Sleep Medicine Tufts Medical Center, Boston, MA

    Nicholas S. Hill MD

  2. Pulmonary Center, Boston University, Boston, MA

    Harrison W. Farber MD

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Humana Press, Totowa, NJ

About this chapter

Cite this chapter

Vieillard-Baron, A., Jardin, F. (2008). Acute Right Ventricular Dysfunction: Focus on Acute Cor Pulmonale. In: Hill, N.S., Farber, H.W. (eds) Pulmonary Hypertension. Contemporary Cardiology™. Humana Press. https://doi.org/10.1007/978-1-60327-075-5_17

Download citation

  • DOI: https://doi.org/10.1007/978-1-60327-075-5_17

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-661-0

  • Online ISBN: 978-1-60327-075-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation