Thread by @SonuAbrahamMD

#MiniTweetorial #Part1 on #RVFailure based on the @NEJM paper by @RyanTedfordMD @Brian_Houston12 !

A must read for all cardiology #ACCFIT fellows and @ACPIMPhysicians residents!
nejm.org/doi/pdf/10.105…

Let's begin !

Part 1 - Mechanisms of RV failure

Let's get started with a poll.

Do you know the various mechanisms of RV failure?

#1 #Pathophysiology

4 Mechanical Mechanisms➡️ >1 can co-exist and are interconnected :
✅Increased preload
✅Increased afterload
✅Decreased contractility
✅Decreased lucitropy

#2 Molecular mechanisms

1. Hypertrophy ➡️ adaptive responses (homeometric adaptation)➡️maladaptive responses (heterometric adaptation) ➡️ VENTRICULOARTERIAL UNCOUPLING

#3 Molecular mechanisms

2. Ischemia
⏫Wall stress & ⏫O2 demand ➡️Demand/supply mismatch ➡️ ISCHEMIA

#4 Molecular mechanisms

3. Metabolic dysfunction
⭐️Normal RV - derives energy from fatty acid metabolism
⭐️RVH ➡️ Relative hypoxia ➡️HIF-1 activation ➡️ Glycolysis
⭐️Mitochondrial dysfunction
⭐️Modifiable risk factors for RV dysfunction:
🗒️ Insulin resistance
🗒️ Obesity

#5 Molecular mechanisms

4. Fibrosis
⭐️Mechanical stress, ischemia, neurohormonal activation ➡️Fibrosis
⭐️Early phase - collagen production - protective against RV dilation
⭐️Later, it leads to 👎diastolic function ➡️ 👎contractility

Let's redo the poll!

Do you understand the various mechanisms by which RV failure develops ?

Stay tuned for #Part2 of the #MiniTweetorial on the concept of RV-PA UNCOUPLING !
#ThePeoplesVentricle
@SaurabhSDani @SarjuGanatraMD @RyanTedfordMD @Brian_Houston12 @AHajduczok @manreetkanwar @AdrianaCMares @NEJM
@ReshadGaranMD @AndrewJSauer