Abstract
Pulmonary hypertension is a disease caused by a multitude of medical conditions which leads to vascular remodeling and increased resistance of the pulmonary circulation. This increased pulmonary vascular resistance and loss of vascular distensibility causes increased afterload for the right ventricle to pump against. Despite adaptive changes to increase contractility, the right ventricle eventually uncouples from the pulmonary circulation, dilates, and goes into failure. Signs of right heart failure may be subtle at first and only detected on imaging and right heart catheterization. However, evolution to right ventricular failure from pulmonary hypertension can be a challenging condition to treat in the intensive care unit with a focus on improving right ventricular contractility, preventing ischemia, and utilizing vasodilator therapy to target afterload reduction. There is a high mortality for those who rapidly progress or fail to respond to medical therapy and the use of extra corporeal membrane oxygenation (ECMO) and lung transplantation is a developing field for only a subset of patients.