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Right Heart Failure Haemodynamics — FRCA Final MCQ

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HardGeneral AnaesthesiaRight Heart Failure HaemodynamicsFRCA Final

A 70-year-old man (ASA IV) with severe tricuspid regurgitation and right heart failure requires emergency laparotomy. Which haemodynamic goal is most important?

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Correct answer: D — Inducing tachycardia to maintain cardiac output

In severe tricuspid regurgitation with RV failure, the goals are: maintain adequate RV preload (cautious fluids), reduce RV afterload (avoid hypoxia, hypercarbia, acidosis, excessive PEEP – all increase pulmonary vascular resistance), avoid myocardial depression, and maintain sinus rhythm. Reducing RV afterload and maintaining preload is key. Excessive PEEP worsens RV function by increasing PVR. Inotropes (milrinone – reduces PVR while improving contractility, or dobutamine) may be needed.

Reference: ESC – 2021 – Valvular heart disease guidelines; RCOA – 2023 – Cardiac anaesthesia