TY - CHAP M1 - Book, Section TI - Ventricular Dysfunction in Critical Illness A1 - Walley, Keith R. A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. PY - 2015 T2 - Principles of Critical Care, 4e AB - Cardiac pump dysfunction may be due to ventricular dysfunction, compression by surrounding structures (eg, cardiac tamponade), increased afterload, valvular dysfunction, and/or abnormal heart rate and rhythm.Ventricular dysfunction may be due to decreased systolic contractility and/or increased diastolic stiffness and may involve right and/or left ventricles.Systemic vascular factors controlling venous return, and their interaction with cardiac pump function, must be considered in order to identify and treat causes of inadequate cardiac output.Myocardial ischemia, relative to demand, is the most common acute reversible contributor to depressed contractility but exogenous toxins and drugs (β-blockers, Ca2+ channel blockers, etc), a myocardial inflammatory response (due to ischemia-reperfusion, sepsis, etc), hypoxemia, acidosis, ionized hypocalcemia and other electrolyte abnormalities, and hypo- and hyperthermia also contribute.Management of acute-on-chronic heart failure progressively includes oxygen; optimizing preload with diuretics, morphine, and nitrates or fluid infusion for hypovolemia; afterload reduction (including positive pressure ventilation); increasing contractility using catecholamines or phosphodiesterase inhibitors; antiarrhythmic drugs and resynchronization using biventricular pacing; intra-aortic balloon counterpulsation, ventricular assist and ECMO devices; and cardiac transplantation. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesssurgery.mhmedical.com/content.aspx?aid=1107717011 ER -