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The Role of Nitric Oxide and Vasopressin in Refractory Right Heart Failure

The standard treatment for right heart failure includes aggressive fluid resuscitation, inotropic agents, and avoiding drugs, such as diuretics or nitrates, or maneuvers that decrease preload. Even an increase in vagal tone caused by the insertion of a bladder catheter can acutely decrease preload and lead to cardiogenic shock. Other modalities include early reperfusion therapy and pacemaker implantation for complete heart block or loss of atrioventricular synchrony. Acute right heart failure carries a very high mortality because of the limited options available for its management. Among newer treatments, inhaled nitric oxide and intravenous vasopressin have shown promise for acute right ventricular failure.