Case of the Month #31 Mitral stenosis and RV failure

 The right ventricle has a much flatter Frank-starling curve compared to the left ventricle and is intolerant of pressure overload. As the right ventricle fails, it distends and there is an increase in myocardial wall stress. It cannot generate an adequate preload to the left ventricle.  The interventricular septum now bows into the left ventricle further impeding left ventricular filling (ventricular interdependence). The left ventricle output now falls and cannot maintain adequate systemic pressure, thus compromising right ventricular perfusion and a vicious cycle of worsening failure.