重症肺动脉高压致急性右心功能不全

重症肺动脉高压致急性右心功能不全内容摘要：

d ending at the infundibulum. – Inward movement of the free wall (bellows effect) – Contraction of the longitudinal fibers, which shortens the long axis. – Traction of the free wall caused by contraction of the LV. (wringing effect)  Shortening of the RV is greater longitudinally than contrast to the LV, twisting and rotational movements do not contribute significantly to RV contraction.  This leads to near plete emptying of the RVreduced RVEDPOptimal Venous return. 6  Right Ventricular Perfusion – In a right dominant system。  Lateral Wall Marginal branches of RCA  Posterior and Inferoseptal PDA  Anterior and Anteroseptal Branches of LAD  RCA is relatively resistant to ischemia pared to the LV. – Lower oxygen consumption – More extensive collateral system – The ability to increase its O2 extraction during increase demand.  Normally proximal RCA flow occurs in both diastole and Systole. Unlike LCA flow to the LV. This is secondary to the transmural pressure generated during systole. 7 Aortic Pressure and Coronary Blood Flow • The response of the RV and LV to experimental increase in afterload. Pathophysiology of failing RV Piazza, G. et al. Chest 2020。 128:18361852 2020年美国 Dana point 分类 18 Autonomic nervous system • In a dog model of RV failure caused by pulmonary artery banding, demonstrated a decrease in betaadrenergic receptor density in the stressed RV. Interestingly, the reduced betaadrenergic receptor density was not limited to the failing ventricle but also occurred in the LV. • In patients with PAH, elevated catecholamine levels were associated with higher pulmonary vascular resistance and lower cardiac index. 19。