RT Book, Section
A1 Walley, Keith R.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Kress, John P.
SR Print(0)
ID 1107717011
T1 Ventricular Dysfunction in Critical Illness
T2 Principles of Critical Care, 4e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071738811
LK accessmedicine.mhmedical.com/content.aspx?aid=1107717011
RD 2024/04/19
AB Cardiac  pump  dysfunction  may  be  due  to  ventricular  dysfunction,  compression  by  surrounding  structures  (eg,  cardiac  tamponade),  increased  afterload,  valvular  dysfunction,  and/or  abnormal  heart  rate  and  rhythm.Ventricular  dysfunction  may  be  due  to  decreased  systolic  contractility  and/or  increased  diastolic  stiffness  and  may  involve  right  and/or  left  ventricles.Systemic  vascular  factors  controlling  venous  return,  and  their  interaction  with  cardiac  pump  function,  must  be  considered  in  order  to  identify  and  treat  causes  of  inadequate  cardiac  output.Myocardial  ischemia,  relative  to  demand,  is  the  most  common  acute  reversible  contributor  to  depressed  contractility  but  exogenous  toxins  and  drugs  (β-blockers,  Ca2+  channel  blockers,  etc),  a  myocardial  inflammatory  response  (due  to  ischemia-reperfusion,  sepsis,  etc),  hypoxemia,  acidosis,  ionized  hypocalcemia  and  other  electrolyte  abnormalities,  and  hypo-  and  hyperthermia  also  contribute.Management  of  acute-on-chronic  heart  failure  progressively  includes  oxygen;  optimizing  preload  with  diuretics,  morphine,  and  nitrates  or  fluid  infusion  for  hypovolemia;  afterload  reduction  (including  positive  pressure  ventilation);  increasing  contractility  using  catecholamines  or  phosphodiesterase  inhibitors;  antiarrhythmic  drugs  and  resynchronization  using  biventricular  pacing;  intra-aortic  balloon  counterpulsation,  ventricular  assist  and  ECMO  devices;  and  cardiac  transplantation.