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534 PA R T IV / Pathophysiology and Management of Heart Disease

Table 22-6 ■ MAJOR DIFFERENCES IN THE LOW CARDIAC OUTPUT SYNDROMES OF PREDOMINANT RIGHT
VENTRICULAR VERSUS LEFT VENTRICULAR INFARCTION
Right Ventricle Left Ventricle
Physical examination Clear lungs Crackles, pulmonary edema
Systemic venous congestion No systemic venous congestion
Jugular venous distention Normal jugular veins
S 3 or S 4 may be present S 3 or S 4 may be present
Tricuspid regurgitation Mitral regurgitation
Hemodynamic profile CI 2.2 L/min/m 2 CI 2.2 L/min/m 2
PAWP 18 mm Hg
Decreased preload
Treatment Increase preload Decrease preload
Volume dependent Limit volume administration
Avoid diuretics and nitrates Give diuretics and nitrates
Give inotropes Give inotropes
Reduce RV afterload by decreasing PA pressure (milrinone) Reduce LV afterload and increase myocardial perfusion with IABP
Reperfuse Reperfuse

CI, cardiac index; PAWP, pulmonary artery wedge pressure; IABP, intra-aortic balloon pump.

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