HVAD patient with chronic RV failure on home milrinone admitted with multi focal PNA. RA - 18, MAP 65 on DBA / Levophed + mechanical ventilation, PEEP 5. HVAD waveform loses pulsatility during inspiration on vent. What do you think is going on?
My thoughts: LV filling is further impaired (during inspiration) by an already under-filled LV due to pre-existing RV failure + RV->LV septal bowing.

Your thoughts?
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