This chapter is on intensive care unit management of patients with right heart failure. The right heart failure is, a clinical syndrome resulting from the inability of the right ventricle to provide adequate blood flow to the pulmonary circulation at a normal central venous filling pressure. The right ventricle (RV) is a thin-walled, crescent-shaped structure that is adapted to eject into the pulmonary circulation. Right ventricular failure (RVF) remains a real clinical challenge for cardiologists, intensive care unit (ICU) and emergency physicians. Pulmonary hypertension and RVF are intricately linked and acute or acute on chronic worsening in pulmonary hypertension, constitutes the most common cause of RVF in the ICU. LV failure, RV ischemia, acute pulmonary embolism, pulmonary hypertension, sepsis, acute lung injury, cardiac tamponade and postcardiothoracic surgery states are the most common etiologies of RVF in the ICU. Treatment of right ventricular failure, lung transplantation, bridging, and extracorporeal life support (ECLS), and ethical considerations and end-of-life care are also discussed in this chapter.