Fig. 1

Pathophysiology of right ventricular (RV) failure. An acute event (A) triggers right ventricular pressure and volume overload and dysfunction (B), causing flattening of the interventricular septum (black arrow). Subsequently, the right ventricular end-diastolic pressure begins to rise, the right ventricle begins to dilate (C), and tricuspid regurgitation worsens. As the interventricular septum further bows into the left ventricle with concomitant pericardial constriction (pink arrows), the right ventricle becomes ischemic from decreased perfusion and begins to fail (D), dropping its cardiac output (blue arrow). The failing right ventricle then compromises left ventricular filling (E), causing rising left ventricular end-diastolic pressures and left ventricular failure. As systemic cardiac output drops (red arrow), ensuing hypotension results in multi-organ failure and possibly death. Definition of abbreviations: RV, right ventricular; LV, left ventricle; CO, cardiac output; ARDS, adult respiratory distress syndrome; PAH, pulmonary arterial hypertension; IVS, interventricular septum; PVR, pulmonary vascular resistance; RVEDP, right ventricular end-diastolic pressure; TR, tricuspid regurgitation; LVEDP, left ventricular end-diastolic pressure