306. Decompensated Right Ventricular Failure in Pulmonary Arterial Hypertension with Dr. Mardi Gomberg-Maitland and Dr. Rachel Damico

The CardioNerds and Pulm PEEPs collaborate for an episode focusing on the management of decompensated right ventricular failure in pulmonary arterial hypertension. Experts Dr. Rachel Damico and Dr. Mardi Gomberg-Maitland discuss a case of a 21-year-old woman with severe PAH, covering the initial assessment, definitions of RV dysfunction and failure, common triggers for decompensation, and the influence of atrial arrhythmias. They delve into echocardiographic and catheterization data, practical differences between RV and LV failure, and management strategies including preload normalization, afterload reduction, RV perfusion maintenance, and addressing potential triggers. The discussion also covers the use of pulmonary vasodilators, inotropes, pressors, mechanical support, and the importance of oxygenation, concluding with a discussion on prognosis, code status, and patient/family communication.