Clinical Manifestations and Diagnosis of Right Ventricular Failure

Right ventricular (RV) failure is a complex clinical syndrome characterized by impaired RV filling and ejection.RV function is altered in the setting of either pressure overload or volume overload.RV failure may result from a primary reduction of myocardial contractility caused by ischemia, cardiomyopathy, or arrhythmia, but left ventricular (LV) failure remains the leading cause.As RV dysfunction progresses to RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, leading to increasing venous congestion.Ventricular interdependence may result in impaired LV filling, a decrease in LV stroke volume, and low cardiac output.The important clinical manifestations of RV failure are fluid retention, decreased systolic reserve, low cardiac output, or arrhythmias.The initial diagnosis is based on clinical history and physical examination.A chest X-ray, electrocardiogram, and biochemical tests should be routinely obtained to evaluate the underlying causes and comorbidities.Bedside echocardiography provides valuable information on cardiac structure and function.RV ejection fraction is the most commonly used index of RV function although it is a highly load-dependent index.(Korean J Med 2016;91:131-138)