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🫁 Pulmonary Hypertensive Crisis/Acute RV Failure

UseUse when a PH patient deteriorates with hypotension, hypoxia/hypercapnia, tachyarrhythmia, or impending intub…

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SourceHumbert M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension…

Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
Stored on this device for revisit reminders

This-shift next steps

After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.

Scene next step
📋heart failureOpen scene pack →
Related scores
Matching pathway
🧭ahfOpen pathway →
Score + version; reference only — not a substitute for care · no HIS write

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Methodology · worked example, guidelines & full notes
Clinical takeaway

Keep RV preload appropriate, lower PVR, augment RV contractility, and maintain SVR > PVR to prevent RV ischemia; never abruptly stop home PAH-targeted therapy. (original synthesis · not guideline verbatim)

When to use

Use when a PH patient deteriorates with hypotension, hypoxia/hypercapnia, tachyarrhythmia, or impending intubation, to organize support around preserving the right ventricle and keeping SVR above PVR.

How it works

Management by problem: hypotension (norepinephrine + dobutamine/milrinone, inhaled NO/epoprostenol); hypoxia/hypercapnia (correct triggers, lung-protective ventilation); arrhythmia (restore sinus rhythm, AV synchrony); peri-intubation (pre-start vasopressors, minimal sedation).

Key points

  • Keep RV preload appropriate, lower PVR, augment RV contractility, and maintain SVR > PVR to prevent RV ischemia; never abruptly stop home PAH-targeted therapy. (original synthesis · not guideline verbatim)
  • Norepinephrine is the preferred vasopressor (raises PVR less than phenylephrine); inhaled NO or epoprostenol selectively lowers PVR without systemic hypotension.
  • Intubation can precipitate sudden, hard-to-reverse collapse; for drug-refractory cases consider VA-ECMO as a bridge.

References

Worked calculation

The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.

Main problemHypoxia/hypercapnia (PVR-raising trigger)

→PH crisis managementSee management points

  • Correct triggers：Avoid hypoxia, hypercapnia, acidosis (all raise PVR); high-flow oxygen to keep SpO₂ > 90%; correct acidosis
  • Ventilation：Lung-protective low tidal volume; avoid excessive PEEP (raises RV afterload); improving oxygenation reduces hypoxic pulmonary vasoconstriction
  • Overall principle：Keep RV preload appropriate (avoid over/under), lower RV afterload (lower PVR), augment RV contractility, maintain systemic perfusion pressure (SVR > PVR to prevent RV ischemia); do not interrupt/restart home PAH-targeted therapy as soon as possible
Verification & sources · governance
FAQ

Frequently asked questions

What are the limits and cautions when using Pulmonary Hypertensive Crisis/Acute RV Failure?
For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
Does Pulmonary Hypertensive Crisis/Acute RV Failure upload patient data? Where is it calculated?
Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
How is Pulmonary Hypertensive Crisis/Acute RV Failure calculated in practice? Can you show a worked example?
Inputs: Main problem Hypoxia/hypercapnia (PVR-raising trigger) → Result: PH crisis management See management points（Correct triggers: Avoid hypoxia, hypercapnia, acidosis (all raise PVR); high-flow oxygen to keep SpO₂ > 90%; correct acidosis, Ventilation: Lung-protective low tidal volume; avoid excessive PEEP (raises RV afterload); improving oxygenation reduces hypoxic pulmonary vasoconstriction, Overall principle: Keep RV preload appropriate (avoid over/under), lower RV afterload (lower PVR), augment RV contractility, maintain systemic perfusion pressure (SVR > PVR to prevent RV ischemia); do not interrupt/restart home PAH-targeted therapy as soon as possible）
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