Diagnosis and treatment of right ventricular failure secondary to acutely increased right ventricular afterload (acute cor pulmonale). A Clinical Consensus Statement of the Association for Acute CardioVascular Care (ACVC) of the ESC.

Acute right ventricular failure secondary to acutely increased right ventricular afterload (acute cor pulmonale) is a life-threatening condition that may arise in different clinical settings. Patients at risk of developing or with manifest acute cor pulmonale usually present with an acute pulmonary disease (e.g., pulmonary embolism, pneumonia, ARDS) and are managed initially in emergency departments and later in intensive care units. According to the clinical setting, other specialties are involved (cardiology, pneumology, internal medicine). As such, coordinated delivery of care is particularly challenging but, as shown during the COVID-19 pandemic, has a major impact on prognosis. A common framework for the management of acute cor pulmonale with inclusion of the perspectives of all involved disciplines is urgently needed.The scope of this Clinical Consensus Document is to provide an updated practical overview of the anatomical and physiological peculiarities of the right ventricle with particular focus on the pathophysiology of acute cor pulmonale, modern diagnostic approach to acute right ventricular failure including risk stratification, and contemporary management of acute cor pulmonale including specific treatment and mechanical circulatory and ventilatory support. The document includes the points of view of cardiologists, pulmonologists, emergency physicians, and intensivists involved in the care of these patients and focuses on the acute management occurring in emergency departments and intensive cardiovascular care units.