The key role of the RV in the pathogenesis of acute pulmonary oedema

Dear Editor, The article entitled ‘The pathophysiology of hypertensive acute heart failure’1 provides an excellent contemporary review of mechanisms involved in the development of acute pulmonary oedema (APO). We wish to highlight the potential important role of the RV in the pathogenesis of APO.2 APO is often thought to result from backward pressure where a disease of the LV causes the LV end-diastolic pressure (LVEDP) to rise, resulting in elevated pulmonary venous pressure and, hence, pulmonary capillary hydrostatic pressure. However, an increase in a given pressure can only occur if pressure energy is added or converted from kinetic to pressure energy. Since the conversion of kinetic energy to pressure energy is too small to result in a significant rise in pressure, the latter cannot be a dominant mechanism. We suggest that extra pressure energy is added by the RV.3 If the LV stroke...
Source: Heart - Category: Cardiology Authors: Tags: PostScript Source Type: research