弹性
心脏病学
冲程容积
医学
内科学
心输出量
血流动力学
冲程(发动机)
舒张期
收缩
心力衰竭
射血分数
呼吸系统
血压
物理
热力学
作者
Sheldon Magder,Douglas Slobod,Nawaporn Assanangkornchai
标识
DOI:10.1164/rccm.202106-1564so
摘要
Right ventricular (RV) dysfunction is a commonly considered cause of low cardiac output in critically ill patients. Its management can be difficult and requires an understanding of how the RV limits cardiac output. We explain that RV stroke output is caught between the passive elastance of the RV walls during diastolic filling and the active elastance produced by the RV in systole. These two elastances limit RV filling and stroke volume and consequently limit left ventricular stroke volume. We emphasize the use of the term “RV limitation” and argue that limitation of RV filling is the primary pathophysiological process by which the RV causes hemodynamic instability. Importantly, RV limitation can be present even when RV function is normal. We use the term “RV dysfunction” to indicate that RV end-systolic elastance is depressed or diastolic elastance is increased. When RV dysfunction is present, RV limitation occurs at lowerpulmonary valve opening pressures and lower stroke volume, but stroke volume and cardiac output still can be maintained until RV filling is limited. We use the term “RV failure” to indicate the condition in which RV output is insufficient for tissue needs. We discuss the physiological underpinnings of these terms and implications for clinical management.
科研通智能强力驱动
Strongly Powered by AbleSci AI