Acute Right Ventricular Failure in the Medical ICU

Right ventricular failure (RVF) is a complex clinical syndrome resulting from anatomical and physiological dysfunction of the right ventricle, marked by insufficient cardiac output state, elevated filling pressures, and elevated central venous pressures. Historically, acute RVF in the medical intensive care unit (MICU) has posed significant diagnostic and therapeutic challenges, often leading to poor patient outcomes and increased healthcare utilization. RVF is a pervasive and critically underdiagnosed condition in MICUs, often masked by nonspecific symptoms and overlooked in favor of left-sided pathology, despite its profound impact on patient outcomes and mortality. This difficulty stems from a limited understanding of its underlying mechanisms and a lack of high-quality evidence to guide management in critical care settings. Effective care for RVF demands early recognition, precise identification of the underlying etiology, and prompt, targeted interventions. Intensivists must possess comprehensive knowledge and a diverse skill set to navigate these complexities and address unforeseen complications. Over the past two decades, advancements in diagnostic and therapeutic technologies have transformed the approach to RVF, driving significant progress in the field. This review explores the historical evolution, pathophysiology, clinical presentation, and contemporary management strategies for RVF in the MICU.