Dr. Crowley discusses early identification and management of RV failure. He presents two cases and discusses the effects of LV support in patients with RV failure and the relationship of RV failure to LV failure. Dr. Crowley emphasizes that RV failure is often under-recognized and increases risk of mortality. He warns about escalating norepinephrine doses and highlights early intervention as the key to avoiding morbidity and mortality. Dr. Crowley is the Heart Center ICU ECMO director at Massachusetts General Hospital.