I. General treatment measures include control of fluid retention, restriction of sodium intake (<2 g/d), weight monitoring, and careful application of diuretics; graded physical activity in right heart failure patients with combined pulmonary hypertension may be beneficial, and recent studies have shown that moderate intensity exercise activities in patients with chronic severe pulmonary hypertension can significantly improve exercise capacity and quality of life; isometric exercise may be associated with syncope and should be limited or avoided; combined right Pregnant women with combined right heart failure have higher maternal and fetal mortality, with the highest risk in the fourth to sixth months of pregnancy and during delivery. It is also important to identify common causes of worsening clinical symptoms: poor medication compliance, unrestricted diet, including non-steroidal anti-inflammatory drugs, non-dihydropyridine calcium antagonists, antiarrhythmic drugs; systemic diseases such as sepsis, anemia, hyperdynamic circulatory states, hypoxemia, hypercapnia; cardiovascular factors such as arrhythmias, myocardial ischemia, pulmonary embolism, obstructive sleep apnea, high altitude, etc. For example, patients with pulmonary hypertension should be treated according to the classification. Prostaglandins, phosphodiesterase inhibitors and endothelin receptor antagonists may be effective in pulmonary hypertension, and the combination of the three drugs can significantly improve the patient's activity tolerance; patients with acute decompensated pulmonary hypertension should inhale NO, intravenous or inhaled epoprostenol Patients with acute decompensated pulmonary hypertension are often treated with inhaled NO, intravenous or inhaled epoprostenol, iloprost, and positive inotropic agents; total heart failure combined with elevated pulmonary venous pressure should be treated for control of heart failure and fluid retention; pulmonary hypertension due to parenchymal lesions and/or hypoxemia is treated primarily with oxygen therapy, assisted ventilation, and treatment of the primary cause of hypoxemia; such patients usually do not benefit from pulmonary vasodilator therapy; treatment of embolic disease includes anticoagulation. Thrombolysis and thrombectomy may be considered in patients with combined hemodynamic disturbances; however, thrombolysis in patients with right ventricular dysfunction and no clinical shock remains controversial. Pulmonary endarterectomy may be life-saving in patients with CTEPH; RVMI combined with inferior wall ST-segment elevation has a high short-term mortality rate, and reperfusion therapy should be prioritized. Reperfusion therapy may improve RVEF and reduce the incidence of conduction block. Thrombolytic therapy for RVMI has a high failure rate, and percutaneous coronary intervention (PCI) is recommended. In patients with valvular heart disease or congenital heart disease, surgery or intervention should be considered. Clinical assessment of preload in patients with right heart failure is still controversial, and the assessment indexes related to acute and chronic right heart failure are different, and central venous pressure and right ventricular end-diastolic pressure sometimes do not reflect preload status. Treatment of pulmonary hypertension can result in significant improvement in exercise tolerance and right ventricular function. A recent study showed that inhaled NO may be beneficial in patients with RVMI combined with cardiogenic shock, and the hemodynamic improvement of NO may be related to selective pulmonary vasodilation and reduction of right ventricular afterload. In patients with RVMI, dobutamine can increase cardiac index and beat-to-beat output to maintain preload; in patients with pulmonary hypertension, dobutamine 2-5 μg/(kg/min) can increase cardiac output and reduce pulmonary vascular resistance. The combination of dobutamine and inhaled NO has also shown clinical benefit in patients with pulmonary hypertension; dobutamine can be used in combination with severe hypotension, and the combination of milrinone can be considered in patients with arrhythmias due to dobutamine application or in combination with β-blockers. The short-term use of digoxin in patients with pulmonary hypertension can increase cardiac output by about 10%, but data on long-term use in patients with pulmonary hypertension are still limited. Digoxin therapy in patients with COPD does not improve maximal oxygen consumption or exercise tolerance, nor does it improve RVEF. Maintaining sinus rhythm is particularly important in patients with right heart failure to maintain sinus rhythm and control ventricular rate. In high atrioventricular block or atrial fibrillation, hemodynamics can be affected. Sequential atrial pacing or electrical resuscitation (tachyarrhythmia) can be considered depending on the change in condition. VII. Right ventricular resynchronization therapy Right ventricular resynchronization therapy is in its initial stage. Some studies have shown that it can improve hemodynamic status and RVEF. VIII. Prevention of sudden death The assessment of the risk of sudden death in patients with right heart failure remains difficult. Existing relevant studies have focused on ARVD and tetralogy of Fallot. The prolonged QRS interval (≥180 ms) in patients with Farrow's tetralogy has a good sensitivity for predicting sustained ventricular tachycardia and sudden death, but the specificity is slightly poorer. Treatment of the primary cause of right heart failure may improve the incidence of ventricular tachycardia or sudden death. Buried cardioverter-defibrillators (ICDs) are indicated for patients with ARVD, high-risk factors (history of previous cardiac arrest, history of sustained ventricular tachycardia episodes, patients at high risk for ventricular tachycardia episodes), etc. Catheter ablation may be considered for monomorphic ventricular tachycardia. Anticoagulation is usually recommended for intracardiac thrombosis, confirmed embolic disease (pulmonary emboli or paradoxical emboli), pulmonary hypertension (primary pulmonary hypertension and pulmonary hypertension associated with scleroderma and congenital heart disease require expert decision); pulmonary hypertension with significant right ventricular dysfunction combined with paroxysmal or persistent atrial flutter (atrial flutter), atrial fibrillation is mostly recommended; previous episodes of embolic events without Patients with previous episodes of embolic events without reversible factors; mechanical right atrioventricular valve or pulmonary valve. BNP therapy is still controversial. XI. Oxygen therapy and adjuvant ventilation Hypoxemia can lead to pulmonary vasoconstriction and cause pulmonary hypertension. Oxygen therapy is indicated for patients with right heart failure combined with hypoxemia at rest or during exercise; patients with right heart failure with pulmonary circulation-body circulation shunts usually do not benefit; when using device assisted ventilation in patients with right heart failure, care should be taken to avoid endogenous positive end-expiratory pressure, end-inspiratory pressure ≥30 mmHg, permissive hypercapnia, acidosis, and alveolar hypoxia. XII. Atrial septal stoma The therapeutic effect in pulmonary hypertension is not conclusive and has only been reported in case reports or small retrospective studies. It is not recommended for right atrial pressure >20 mmHg, pulmonary vascular resistance >55 Woods units, and 1-year survival expected to be <40%. XIII. Heart transplantation Heart transplantation is indicated in selected patients with intractable right heart failure. Right ventricular assist devices In patients with acute right heart failure who are not responding to pharmacological therapy, right ventricular assist devices may provide short-term support for palliation or pending surgical treatment. Permanent implantation of an assist device has not been studied.