Right Ventricular Heart Failure From Pulmonary Embolism: Key Distinctions From Chronic Pulmonary Hypertension

John A. Watts, Michael R. Marchick, Jeffrey Kline

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background: The right ventricle normally operates as a low pressure, high-flow pump connected to a high-capacitance pulmonary vascular circuit. Morbidity and mortality in humans with pulmonary hypertension (PH) from any cause is increased in the presence of right ventricular (RV) dysfunction, but the differences in pathology of RV dysfunction in chronic versus acute occlusive PH are not widely recognized. Methods and Results: Chronic PH that develops over weeks to months leads to RV concentric hypertrophy without inflammation that may progress slowly to RV failure. In contrast, pulmonary embolism (PE) results in an abrupt vascular occlusion leading to increased pulmonary artery pressure within minutes to hours that causes immediate deformation of the RV. RV injury is secondary to mechanical stretch, shear force, and ischemia that together provoke a cytokine and chemokine-mediated inflammatory phenotype that amplifies injury. Conclusions: This review will briefly describe causes of pulmonary embolism and chronic PH, models of experimental study, and pulmonary vascular changes, and will focus on mechanisms of right ventricular dysfunction, contrasting mechanisms of RV adaptation and injury in these 2 settings.

Original languageEnglish (US)
Pages (from-to)250-259
Number of pages10
JournalJournal of Cardiac Failure
Volume16
Issue number3
DOIs
StatePublished - Mar 2010
Externally publishedYes

Fingerprint

Right Ventricular Dysfunction
Pulmonary Embolism
Pulmonary Hypertension
Heart Failure
Blood Vessels
Vascular Capacitance
Wounds and Injuries
Right Ventricular Hypertrophy
Pressure
Lung
Chemokines
Pulmonary Artery
Heart Ventricles
Theoretical Models
Ischemia
Pathology
Cytokines
Inflammation
Morbidity
Phenotype

Keywords

  • inflammation
  • Pulmonary hypertension
  • right ventricular failure
  • right ventricular hypertrophy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Right Ventricular Heart Failure From Pulmonary Embolism : Key Distinctions From Chronic Pulmonary Hypertension. / Watts, John A.; Marchick, Michael R.; Kline, Jeffrey.

In: Journal of Cardiac Failure, Vol. 16, No. 3, 03.2010, p. 250-259.

Research output: Contribution to journalArticle

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