Vasopressin vs IV fluids for acute right heart failure

Zookeeper3 · Oct 5, 2009

It's a bit more complicated than one vrs the other because of all the multiple comorbidities that can be going on as well as the medication list and how advanced the heart failure is. In addition how symptomatic the patient is and what type of advance monitoring is available to you.

If I have a tripple lumen I hook it up for CVP readings in right heart failure. If I don't have a biventricular failure then I usually give 250cc NS bolus at a time until the MAP is restored or symptoms lesson or the cvp reaches a certain point. Urine output is something I look at too.

If this is a renal failure patient and many of the right sided failures are hepatic-renal failures than vasopressin doesn't really work and your in a bind because you need fluid. Well if you overshoot can always pull off with hemo anyway.

So I like fluid assuming this is the run of the mill right sided failure. When I worked transplant, things were handled quite differently then the general population.

Protoman2050 · Oct 5, 2009

It's a bit more complicated than one vrs the other because of all the multiple comorbidities that can be going on as well as the medication list and how advanced the heart failure is. In addition how symptomatic the patient is and what type of advance monitoring is available to you.
If I have a tripple lumen I hook it up for CVP readings in right heart failure. If I don't have a biventricular failure then I usually give 250cc NS bolus at a time until the MAP is restored or symptoms lesson or the cvp reaches a certain point. Urine output is something I look at too.
If this is a renal failure patient and many of the right sided failures are hepatic-renal failures than vasopressin doesn't really work and your in a bind because you need fluid. Well if you overshoot can always pull off with hemo anyway.
So I like fluid assuming this is the run of the mill right sided failure. When I worked transplant, things were handled quite differently then the general population.

I was talking about acute right heart failure, like an inferior wall AMI that affects the right ventricle. Everything's fine until your right ventricle infarcts and can no longer pump well.

And, since inferior wall AMIs can also cause acute MR, it'd be very interesting to see how you'd manage a pt with a right ventricle infarction and acute MR. They need fluids to maintain LV preload, but since the MV is regurgitating, most of it will go back into the lungs, and cause pulmonary edema. Probably give fluids very cautiously, usingSwan-Ganz catheter to titrate to PCWP, w/ Lasix at the ready.