Review ArticleRight Ventricular Heart Failure From Pulmonary Embolism: Key Distinctions From Chronic Pulmonary Hypertension
Section snippets
PE—Acute Occlusive PH
PE is an acute, occlusive, thromboembolic disorder causing PH that may lead to RV damage.2, 3, 4, 12, 16 By far, most PE arises as a result of embolism from deep vein thrombosis, most commonly from veins in the legs.17 Furthermore, deep vein thrombosis and PE share the same predisposing risk factors, such as inherited hypercoagulable states and acquired factors such as reduced mobility, trauma, pregnancy, oral contraceptives, obesity, and malignancy.17 Acute PH and RV strain may also occur in
Conclusions and Future Directions
Similarities between pulmonary embolism (acute occlusive PH) and chronic PH include the fact that pulmonary circulatory resistance increases, RV tissue converts to the fetal gene profile, and RV function may decline. Furthermore, mortality and morbidity are correlated with the extent of RV dysfunction in both cases. Mechanisms of change within the lungs and heart, however, are drastically different between these 2 types of PH. Acute occlusive PH results from an abrupt blockage of pulmonary
References (105)
- et al.
Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure
J Am Coll Cardiol
(2001) - et al.
Determinants of right ventricular function and hemodynamics after pulmonary embolism
Chest
(1974) - et al.
Usefulness of regional myocardial performance index to diagnose pulmonary embolism in patients with echocardiographic signs of pulmonary hypertension
Am J Cardiol
(2006) - et al.
Pulmonary embolism and right heart function: insights from myocardial Doppler tissue imaging
J Am Soc Echocard
(2006) Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism
Chest
(2002)- et al.
Right ventricular damage due to pulmonary embolism: examination of the number of infiltrating macrophages
Forensic Sci, Int
(2003) - et al.
Right ventricle injury during acute pulmonary embolism leads to its remodeling
Int J Cardiol
(2008) - et al.
Prognostic significance of troponin elevation and right ventricular enlargement in acute pulmonary embolism
Am J Cardiol
(2005) - et al.
Complications of body sculpture: prevention and treatment
Clin Plastic Surg
(2006) - et al.
Inflammation and intimal hyperplasia associated with experimental pulmonary embolism
J Vasc Surg
(2002)
A new model of pulmonary microembolism in the mouse
J Pharmacol Methods
Experimental pulmonary embolism: effects of the thrombus and attenuation of pulmonary artery injury by low-molecular-weight heparin
J Vasc Surg
Cardiac inflammation contributes to right ventricular dysfunction following experimental pulmonary embolism in rats
J Molec Cell Cardiol
A new animal model for pulmonary hypertension based on the overexpression of a single gene, angiopoietin-1
Ann Thorac Surg
Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th ed)
Chest
The release of thromboxane A2 and prostacyclin following experimental acute pulmonary embolism
Prostagland Leukotrienes Med
Contributions of prostaglandin F2alpha and thromboxane A2 to the acute cardiopulmonary changes of pulmonary embolism
J Surg Res
Reduction in plasma haptoglobin in humans with acute pulmonary embolism causing tricuspid regurgitation
J Thromb Haemostasis
Sildenafil selectively inhibits acute pulmonary embolism-induced pulmonary hypertension
Pulmon Pharmacol Therapeutics
Molecular and cellular basis of pulmonary vascular remodeling in pulmonary hypertension
Progr Cardiovasc Dis
Prognostic value of echocardiographic right/left ventricular end-diastolic diameter ratio in patients with acute pulmonary embolism: results from a monocenter registry of 1,416 patients
Chest
Metabolic and genetic regulation of cardiac energy substrate preference. Comp Biochem Physiol Part A
Molec Integrative Physiol
Time dependent changes in cytoplasmic proteins of the right ventricle during prolonged pressure overload
J Molec Cell Cardiol
Time dependent changes in cytoplasmic proteins of the right ventricle during prolonged pressure overload
J Molec Cell Cardiol
Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism
Am J Cardiol
Increased troponin I predicts in-hospital occurrence of hemodynamic instability in patients with sub-massive or non-massive pulmonary embolism independent to clinical, echocardiographic and laboratory information
Int J Cardiol
Comparison of 8 biomarkers for prediction of right ventricular hypokinesis 6 months after submassive pulmonary embolism
Am Heart J
Plasma heart-type fatty acid binding protein is superior to troponin and myoglobin for rapid risk stratification in acute pulmonary embolism
Clin Chim Acta
Two cases of right ventricular ischemic injury due to massive pulmonary embolism
Forensic Sci Int
Molecular regulation of cardiac hypertrophy
Int J Biochem Cell Biol
Activation of signaling molecules and matrix metalloproteinases in right ventricular myocardium of rats with pulmonary hypertension
Pathol Res Practice
Mechanisms and functions of agonist-independent activation in the angiotensin II type 1 receptor
Molec Cell Endocrinol
Predictors of mortality from pulmonary embolism and their influence on clinical management
Thromb Haemost
Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review
Eur Heart J
Echocardiographic and functional cardiopulmonary problems six months after first-time pulmonary embolism in previously healthy patients
Eur Heart J
Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle
Circulation
Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure
Circulation
Right heart function and haemodynamics in pulmonary hypertension
Int J Clin Practice
ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association
Circulation
Role of inflammation in right ventricular damage and repair following experimental pulmonary embolism in rats
Int J Exp Pathol
Acute pulmonary embolism
N Engl J Med
Pulmonary hypertension of sickle cell disease: more than just another lung disease
American Journal of Hematology
Pulmonary hypertension and cor pulmonale during severe acute chest syndrome in sickle cell disease
Am J Respir Crit Care Med
Pulmonary complications of sickle cell disease
N Engl J Med
Subacute cor pulmonale due to tumor embolism
Intern Med
The mechanism(s) of hypoxic pulmonary vasoconstriction: potassium channels, redox O(2) sensors, and controversies
News Physiol Sci
Critical care issues in the patient after major joint replacement
J Intens Care Med
Diagnosis and treatment of vascular air embolism
Anesthesiology
Biventricular cardiac dysfunction after acute massive pulmonary embolism in the rat
J Appl Physiol
Experimental pulmonary embolism with electrically activated autologous blood
Res Exp Med
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