In Acute Right Ventricular Failure, What are the Effects of Preload and Afterload?

The right ventricle (RV) differs from the left ventricle teleologically, in its wall structure, and its function as a low-pressure pump connected to a high-capacitance pulmonary system. Acute RV failure presents differently from left ventricular failure and thus management strategies must also differ. It is well known that preload helps in acute RV failure; however, RV failure can occur from an ischemic RV or from increased RV afterload. We attempt to describe 3 different clinical scenarios leading to RV failure, RV ischemia, acute pulmonary embolism, and pulmonary hypertension, with regard to the effect of preload and afterload in all 3 situations.