Right Heart Failure Medical Slides

Emphasize three key differences: (1) the RV is a thin-walled crescent that generates 1/6th the stroke work of the LV, making it exquisitely afterload-sensitive, (2) RV coronary perfusion occurs in both systole and diastole (unlike LV which is predominantly diastolic), so systemic hypotension directly impairs RV perfusion, and (3) interventricular dependence means LV dysfunction impairs RV function through septal shift and shared fibers.

Teach the "Goldilocks" preload concept: the failing RV may be volume-dependent (needing cautious 250 mL fluid boluses with CVP monitoring) or volume-overloaded (requiring diuresis to reduce RV dilation and improve LV filling via septal shift). Avoid systemic vasodilators that worsen hypotension; instead use targeted pulmonary vasodilators (inhaled nitric oxide, inhaled epoprostenol). Maintain systemic BP with vasopressors (norepinephrine preferred) to preserve RV coronary perfusion.

Present RV infarction in the context of inferior STEMI (40% incidence with proximal RCA occlusion). Teach the diagnostic triad: hypotension, clear lungs, elevated JVP. Show right-sided ECG with ST elevation in V4R (sensitivity 88%, specificity 78%). Emphasize volume-dependent management (avoid nitroglycerin, diuretics, and morphine) and the importance of maintaining AV synchrony — temporary pacing for associated high-degree AV block is often necessary.