We did an amazing episode on EMCrit with Susan Wilcox on Right Heart Failure. However, this oft neglected ventricle deserves even more coverage giving how pesky it can be when it fails. So we brought Sara Crager, MD to Stony Brook to give Grand Rounds. You are going to love this lecture. Part 2 is a Q&A and will be released as a separate episode.
Now on to the Podcast…
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Editor-in-Chief, EMCrit.org at EDECMO LLC
An ED Intensivist from NY. No conflicts of interest (coi).
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[…] EMCrit 272 – Right Heart Failure with Sara Crager […]
Magic, crystal clear and very upbeat! Thank you. I think the sales of Flolan and nitric oxide will fall after this presentation!
Wow, so insightful and engaging. great listen
Dr. Crager needs to be in charge of all PowerPoint presentations for everything…ever! Thank you for breaking down a complex topic.
Wow great presentation Dr Crager. I’m speaking as an ED physician from the UK- that’s the best explanation I have ever heard about these patients in 15 years of my practice! Thank you.
Probably one of the best episode/presentation on EMCrit.
I’m blown away – perhaps the best presentation ever?
Absolutely amazing presentation! More Sara Crager! Please make her join the EMCrit team.
Thank-you Sara, Such a helpful & clear breakdown of a (usually) complex topic.
Great talk and great slides! Can’t wait for part two!
Fantastic talk. One question about vasopressors: in paediatrics we use phenylephrine to treat hypercyanotic (tet) spells, as it increases SVR more than PVR, thereby reducing the amount of right-to-left shunt. However, in this talk the opposite is suggested: that phenylephrine increases PVR more than SVR. Is this a physiologic difference between paeds and adults, or is there some other effect going on?
The choice of phenylephrine has more to do with it’s lack of inotropy. It increases SVR more than PVR, but also hypothetically will not cause infundibular spasm that can be caused by vasopressors with inotrpoic effects (epi, norepi).
https://emcrit.org/ibcc/pressors/
Great talk! Very informative and well explained!
Amazing lecture. Makes so much sense. Thank you for posting it.
is there anyway to watch the slide show in time with the podcast? i tried to do it manually but kept getting lost 🙁
Sara Crager is a legend. Where can I find more of her content?
Really wonderful talk. However one “criticism” I have would be with repeated references to “pressure that the RV must overcome.” The pressure is not an entity that is something that exists by itself and that anything needs to overcome in these scenarios, it is rather the PVR that is such a thing (whether by pulmonary vasoconstriction or resistance to flow due to elevated LAP). The pressure seen in the PA is a PRODUCT of the RV contractility producing CO and the PVR. That is why you can have high PAP with crummy (but not critically low) flow in chronic pulmonary… Read more »
Thanks for this excellent lecture. Other than ECMO, are there any tips on resuscitation once the patient is in cardiac arrest?
[…] RV failure by Sara Crager (EMCrit)https://emcrit.org/emcrit/right-heart-sara-crager/ […]
Never in my life, i thought i would be on the edge of my seat while listening to a story about an RV princess. 😉
Very engaging !
Thank you for the amazing talk.
I am wondering why this paragraph in the UpToDate article “Clinical presentation, evaluation, and diagnosis of the nonpregnant adult with suspected acute pulmonary embolism” contains a casual recommendation to give fluids in suspected PE with haemodynamic instability then… is there another reason a patient could be unstable besides right heart strain?