Critical Care Time 70. Right Heart Failure with Dr Matt Siuba
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Feb 23, 2026 
Dr Matt Siuba, a medical intensivist at the Cleveland Clinic who focuses on right ventricular failure and pulmonary vascular care. He explains why the right ventricle matters, contrasts RV versus LV physiology, and walks through bedside monitoring and when to use pulmonary artery catheters. Practical strategies for ventilation, hemodynamics, and escalation to mechanical support are also highlighted.
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Three S's For Rapid Bedside RV Assessment
- For bedside RV assessment use the three S's: size, squeeze, septal kinetics.
- Dr Matt Siuba: on apical 4‑chamber the RV should be ~1/3 of heart, TAPSE >1.7 indicates squeeze, and septal bowing signals RV overload.
Put A PA Catheter Only If It Will Change Management
- Reserve invasive monitoring (pulmonary artery catheter) for high diagnostic uncertainty, very sick patients, or when frequent remeasurement will change management.
- Dr Matt Siuba: if invasive data will guide decisions like MCS or differentiate pre vs postcapillary PH, place a PA catheter.
Common Swan Insertion Pitfalls And Simple Fixes
- Floating PA catheters bedside is doable but often fails from RA looping or misrecognition of waveforms rather than RV coiling.
- Dr Matt Siuba: fluoroscopy helped his mental model; common fix is drop balloon, pull back to ~25 cm, reinflate to redirect tip.
