Caused by respiratory problems, and by progression of left sided heart failure.
RUQ pain - hepatomegaly
Loud P2, and heave
ECG: If the ECG is normal, heart failure is unlikely
Reduced ECG amplitude (more air between heart and leads)
Prominent P waves
Right axis deviation
RBBB (Broad QRS > 120 ms, RSR’ pattern in V1-3 (‘M-shaped’ QRS complex), Wide, slurred S wave in the lateral leads (I, aVL, V5-6))
Sagging of ST segment below baseline
P mitrale (bifid P waves), seen with left atrial enlargement.
P pulmonale (peaked P waves), seen with right atrial enlargement.
P wave inversion, seen with ectopic atrial and junctional rhythms.
Variable P wave morphology, seen in multifocal atrial rhythms.
--> if P waves are inverted check lead placement
Reduce hypoxia and hypercarbia
Ventilation and PEEP
Inotropes and vasopressors
RV assist device may be useful