Sonu Abraham Profile picture
Mar 23, 2023 9 tweets 7 min read Read on X
#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 Image
#2 Molecular mechanisms

1. Hypertrophy ➡️ adaptive responses (homeometric adaptation)➡️maladaptive responses (heterometric adaptation) ➡️ VENTRICULOARTERIAL UNCOUPLING Image
#3 Molecular mechanisms

2. Ischemia
⏫Wall stress & ⏫O2 demand ➡️Demand/supply mismatch ➡️ ISCHEMIA Image
#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 Image
#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 Image
Let's redo the poll!

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

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More from @SonuAbrahamMD

Mar 25, 2023
#MedTweetorial #Part2 on RV Failure based on @NEJM article by @RyanTedfordMD @Brian_Houston12 !

We will discuss RV-PA uncoupling today!

PV loops are a scary thing to many. Refer to this #Tweetorial by my friend @AHajduczok for a primer on PV loops.
#1 This image summarizes all the parts of the PV loop of the left ventricle .

Note the end-systolic pressure, end-diastolic volume and stroke volume specifically to understand the upcoming tweets.
Let’s begin with a poll

Do you understand what RV-PA uncoupling is?
Read 17 tweets

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