In treating acutely decompensated pulmonary arterial hypertension, which main goal should be prioritized?

In the management of acutely decompensated pulmonary arterial hypertension (PAH), the foremost goal is to support right ventricular function. This is due to the unique physiological challenges posed by PAH, where increased pressure in the pulmonary arteries leads to right ventricular overload and dysfunction.

During acute decompensation, the right ventricle faces significant strain as it attempts to overcome elevated pulmonary vascular resistance to maintain adequate blood flow through the lungs. Supporting right ventricular function involves optimizing preload, reducing afterload, and improving overall cardiac output. Interventions may include administering vasodilators to decrease pulmonary vascular resistance, diuretics to manage fluid overload, and possibly inotropic agents if myocardial contractility is compromised.

Addressing left ventricular function, hypotension, or managing sepsis are indeed important components of comprehensive cardiovascular care, but they are secondary to the immediate need to stabilize and support right ventricular performance in patients with PAH. Failure to address right ventricular function can lead to worsening symptoms, further hemodynamic compromise, and increased risk of mortality. Thus, prioritizing strategies that support right ventricular function is critical in these clinical scenarios.