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This page will provide you with a comprehensive overview on the pathophysiology of right sided heart failure, the treatment of right sided heart failure, the management of right sided heart failure and right sided heart failure signs. We sincerely hope that our website helps to further your understanding on the topic of right sided heart failureand its relation to stroke. If you have further questions, please contact a healthcare professional.
What right sided heart failure?
The heart, a vital organ that pumps oxygenated blood throughout the body, is made up of four chambers: two upper chambers (the atria) and two lower ones (the ventricles).Importantly, all of the chambers are connected by various valves and function cooperatively to control both the pressure and flow of blood; thetwo atria function as collection chambers whereas the ventricles are the pumping units. In the first step of the process, deoxygenated blood flows into the right atrium from the circulatory system (specifically from veins).Here, blood collects until there is a contraction (atrial systole) whereby blood is forced through a valve into the right ventricle. All of the valves in the heart are important for preventing blood from flowing backwards, and thus, regulating the direction of blood flow. After filling the right ventricle, the hearts contracts once again and forces blood to the lungs. In the lungs, oxygen is added to the blood through simple diffusion. This process is possible due to the thin and permeable nature of alveoli in the lungs.Once oxygenated, the blood travels back to fill the left atrium, and subsequently, the left ventricle (during diastole). Lastly, the left ventricle contracts to push blood back into the circulatory system (during systole). It is important to note that the entire process occurs simultaneously; the ventricles are contracting together.
When a patient experiences heart failure it is important to recognize the heart has not stopped completely but rather the heart is unable to pump an adequate supply of blood for the body’s function. Specifically, right-sided heart failure occurs when there is resistance to the flow of blood from the right heart structures (right atrium, right ventricle, pulmonary or lung artery) into the lungs or when the tricuspid valve, which separates the right atrium from the right ventricle, fails to work properly. Ultimately, this leads to a backup of fluid and pressure in the veins that empty into the right side of the heart.
Causes of right sided heart failure
Left Sided Heart Failure
One important cause of right-sided heart failure is actually left-sided heart failure. Although there are differences between left and right sided heart failure, it is important to recognize that both sides work together as a functional unit, and thus, affect each other.When the left ventricle fails it means that blood is no longer being pumped out of the heart, and therefore, there is increased fluid pressure being transferred back through the lungs. This ultimately damages the heart’s right side because the right side is essentially being flooded with blood from both sides. Consequently, the right side loses pumping power and blood backs up in the body’s veins, causing right sided heart failure peripheral edema (swelling in the legs and swelling within the abdomen).
Pulmonary Heart Disease
Another important cause of right-sided heart failure is pulmonary heart disease, which is by definition, a condition when the lungs cause the heart to fail. Specifically, difficulties of pulmonary circulation, such as pulmonary hypertension or pulmonic stenosis (narrowing), may cause the heart to enlarge and fail due to vascular resistance. More importantly, tissue damage (e.g. disease, hypoxic injury), and chronic hypoxic pulmonary vasoconstriction, may induce these vascular changes. If the condition is left untreated it may result with death.
Right Sided Heart Failure: Signs
The particular right sided heart failure signs that an individual experiences may be vastly different from those of left sided heart failure. This is simply because there are differences between left and right sided heart failure; the left sided heart failure typically is more important as it is a stronger, larger pump.
Signs may include:
• Shortness of breath
• Swelling of feet and ankles
• Nocturia: Urinating more frequently at night (fluid redistribution occurs while a person is lying down)
• Edema (excess of watery fluid collecting in the cavities or tissues)
• Pronounced neck veins
Notably, right sided heart failure may occur concomitantly or as a consequence of left sided heart failure. As a result of this, there may also be some general signs that are not specifically right sided heart failure signs.
These may include:
• Cough (produces frothy or blood-tinged mucus)
• Decreased urine production
• Difficulty lying down; need to sleep with the head elevated to avoid shortness of breath
• Irregular or rapid pulse
• Sensation of feeling the heartbeat (palpitations)
• Waking up due to shortness of breath (paroxysmal nocturnal dyspnea)
• Weight gain from fluid retention
Right sided heart failure and edema
Without sufficient blood flow all major body functions are disrupted; the body needs the blood for both oxygen and filtration. A common consequence of disrupted blood flow due to the right side is right sided heart failure dependent edema. This condition, as the name right sided heart failure dependent edema suggests, is when there is buildup of excess fluid (edema) in other parts of the body. More specifically, the term “congestive heart failure” is often used to describe a build-up of too much fluid in tissues and veins that causes a “congestion” like feeling. This congestion takes the form of water retention and swelling (edema), both as right sided heart failure peripheral edema (causing swollen limbs and feet) and as right sided heart failure pulmonary edema (causing breathing difficulty).When a person has right sided heart failure peripheral edema they may exhibit weight gain, swelling of the ankles, legs, back, and in extreme cases, fluid accumulation in the abdomen (ascites). A sign of edema in the ankles is an indentation that remains there momentarily after a finger is pressed into the skin. In contrast, when a person has pulmonary edema they begin to experience breathing difficulty. Overall, right sided heart failure and edema are commonly diagnosed together.
Management of Right Sided Heart Failure
Management of right sided heart failure requires periodic monitoring by a health care provider. The goals of treatment include controlling the symptoms, reducing the heart’s workload, and improving the heart’s ability to function. Overall, management of right sided heart failure demands for underlying disorders and causes to be treated if possible.
Due to the fact that the function of the right side of the heart is closely connected to the left side, most common therapy for right-sided heart failure involves also treating left-sided heart failure. This may include valve replacements, procedures such as bypass surgery (CABG) and angioplasty. Importantly, because the left side and right side of the heart functions as one unit, the physician will try to treat both side simultaneously.
One important factor in the management of right sided heart failure is lifestyle. Lifestyle, the way a person lives on a day to day basis, provides a wealth of opportunity for a person for a person to improve their condition. Through simple changes, such as reducing salt intake and the amount of liquids they drink, a person can easily reduce associated conditions such as right sided heart failure dependent edema.Likewise, by losing weight (if overweight),avoiding smoking, and avoiding too much alcohol, an individual can reduce the stresses the body has to cope with. This is essential because there is no cure for heart failure and a physician can only resort to medication, addressing the underlying disorders, and using implanted devices with defibrillation capabilities.
The most common medications used in the management of right sided heart failure include: diuretics (water pills to help reduce fluid accumulation),spironolactone (to prevent salt retention), ACE inhibitors and ARBs (to reduce heart workload), beta-blockers (prevent death) and digitalis (to increase muscle contraction).Importantly, most of the medications focus on affecting consequential relationships, such as right sided heart failure and edema. Unfortunately, if the patient’s condition is severe and they do not respond to these therapies they may require a heart transplant.
For any additional information on right sided heart failure signs or the management of right sided heart failure please contact your local healthcare professional.