الفهرس 
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Abstract
Acute right ventricular heart failure is a common disease that represent a high percent of cases admitted to ICU and it’s treatment represent a challenge to physicians and is associated with major morbidity and mortality. It has a various etiologies which may be cardiac or extracardiac but the most important one is acute pulmonary embolism and right ventricular myocardial infarction.
A patient with ARVF requires immediate clinical and diagnostic evaluation and care in order to select the type of treatment to break the activated vicious circle that is responsible for the disease.
Initial diagnostic assessment should include clinical examination supported by the patient’s history, ECG, chest X-ray, plasma BNP/nt-proBNP, biomarkers of myocardial injury and other ordinary laboratory tests. Echocardiography should be performed in all patients as soon as possible and also right heart catherization.
The initial clinical assessment should include evaluation of pre-load, after-load, and contractility the presence of pulmonary hypertension and other complicating disorders (including valvular complications, arrhythmia, and concomitant co-morbidities such as infection, diabetes mellitus, respiratory or renal diseases). Acute pulmonary embolism are a frequent cause of ARVF and diagnostic CT angiography is often required.
The initial goal is to stabilize the patient’s condition with conservative measures that improve patient condition, limit cardiac ischemia and attenuate the need for hospital admission. Once the patient’s condition is stable, known therapies for congestive heart failure can then be established.
The initial treatment of ARVF consists of:
• Oxygenation with face mask or by CPAP.
• Vasodilatation by nitrate or nitroprusside if the blood pressure is adequate to decrease preload and afterload.
• Diuretic therapy by furosemide or other loop diuretic (initially intravenous bolus followed by continuous intravenous infusion, when needed).
• Other complicating metabolic and organ-specific conditions should be treated.
• Patients with acute right ventricular infarction or other complicated cardiac disorders should undergo cardiac catheterization and angiography with a view to invasive intervention including surgery.
Further specific therapies should be administered based on the clinical and hemodynamic characteristics of the patient who does not respond to initial treatment. This may include the use of inotropic agents or a calcium sensitizer for severe decompensated heart failure, inotropic agents for cardiogenic shock or persistent hypotension and treatment of associated arrhythmias.
Patients with refractory ARFV or end-stage heart failure should be considered for further support, where indicated including: artificial mechanical ventilation, ultrafiltration, dialysis or circulatory assist devices as a temporary measure or as a ‘bridge’ to heart transplantation.
So The aim of therapy of ARVF is to correct hypoxia and increase cardiac output, renal perfusion, sodium excretion and urine output, improve survival rate, decrease length of hospital stay, minimize maintenance and discharge medications, psychological support of patient, educational explanation of nature of disease, medication and it’s complications and strategy to prevent decompensation and readmission after discharge.
Also all hopes are on future researches on genetics, gene therapy, pharmacogenetics, cell based therapy and also mechanical assistance to improve prognosis and early and provided ways in treatment of ARVF.