Cardiovascular Physiology in Obesity

Obesity produces a variety of hemodynamic changes that cause alterations in cardiac morphology and ventricular function. These alterations may be intensified by the presence of systemic hypertension. In those with severe obesity these pathophysiologic sequelae may contribute to the development of left ventricular failure, pulmonary arterial hypertension, and subsequent right ventricular failure. Sleep apnea and obesity hypoventilation may help to promote pulmonary arterial hypertension and further facilitate right heart decompensation. Such patients are at particularly high risk for these complications in the critical care setting. Knowledge of cardiovascular pathophysiology in obesity may assist the intensivist in the successful management of these challenging patients.