Wednesday, January 25, 2023

Right Sided Congestive Heart Failure

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Treatments For Heart Failure

Congestive Heart Failure (CHF) for Nursing & NCLEX

Treatment for heart failure usually aims to control the symptoms for as long as possible and slow down the progression of the condition.

How youre treated will depend on what is causing your heart failure.

Common treatments include:

  • lifestyle changes including eating a healthy diet, exercising regularly and stopping smoking
  • medicine a range of medicines can help many people need to take 2 or 3 different types
  • devices implanted in your chest these can help control your heart rhythm
  • surgery such as a or a heart transplant

Treatment will usually be needed for life.

A cure may be possible when heart failure has a treatable cause. For example, if your heart valves are damaged, replacing or repairing them may cure the condition.

What Are The Symptoms

Your feet, legs, and ankles will likely to swell because blood is backing up in your veins. This symptom is called edema.

  • If it backs up into your stomach or liver, you may notice that your abdomen is distended, too.
  • You might find that you have to go to the bathroom more, especially at night. This is caused by fluid buildup, too.

As your heart failure gets worse, you may also see some of these symptoms:

  • Itâs hard to breathe.
  • Your neck veins are swollen.
  • Your pulse is fast or feels âoff.â
  • Your chest hurts.
  • Youâre gaining weight from excess fluid.
  • You donât feel like eating.
  • Your skin is cold and sweaty.
  • Youâre very tired.

What Causes Congestive Heart Failure In Cats

A variety of factors can cause congestive heart failure in cats. It is most commonly caused by a condition in which the walls of the heart thicken , but it can also be caused by thyroid disease, high blood pressure, or birth defects, among other things. Congestive heart failure can occur in cats of any age, breed , or gender, but it is most common in middle-aged to older cats.

CHF can also develop in a heart that’s been weakened by other heart conditions, so it’s essential to do what you can to prevent heart disease from occurring in your pet, including preventing obesity and providing heartworm prevention.

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Heart Failure With Preserved Ejection Fraction

In diastolic heart failure , the same pathophysiologic processes occur that lead to decreased cardiac output in systolic heart failure, but they do so in response to a different set of hemodynamic and circulatory environmental factors that depress cardiac output.

In HFpEF, altered relaxation and increased stiffness of the ventricle occur in response to an increase in ventricular afterload . The impaired relaxation of the ventricle then leads to impaired diastolic filling of the left ventricle .

Morris et al found that right venticular subendocardial systolic dysfunction and diastolic dysfunction, as detected by echocardiographic strain rate imaging, are common in patients with HFpEF. This dysfunction is potentially associated with the same fibrotic processes that affect the subendocardial layer of the LV and, to a lesser extent, with RV pressure overload. It may play a role in the symptomatology of patients with HFpEF.

What Is Heart Failure

Congestive heart failure etiology and pathophysiology

Heart failure occurs when the heart is not able to pump enough blood to the body. The adult heart pumps almost two gallons of blood every day to meet the demands of the bodys organs.

The disease is a chronic, long-standing condition. Its symptoms, if left untreated, could be detrimental or even deadly.

Initially, the heart will try to make up for the failure through the following means:

  • Enlargement of the heart: To meet the target workload, the heart will enlarge itself so it can pump with more pressure and thus ensure that oxygenated blood reaches the entire body in the required proportions. However, when the heart enlarges itself, the body retains fluid, the lungs become congested with fluid, and the heart beats irregularly. This causes cardiac arrhythmia , symptoms of which include dizziness, chest pain, and shortness of breath.
  • Increase in muscle mass: By building more muscle mass, the heart can contract forcefully and thus pump more blood, at least initially.
  • Forceful pumping: By pumping more forcefully, the heart can output more blood.

In addition to the heart, the body itself will also try to make up for the failure through the following methods:

  • Blood vessels narrow or decrease in width. Thus, they increase pressure so that blood can sufficiently reach the body.
  • The body diverts blood from less important tissues and organs, like the kidneys, and sends blood to more important organs, like the brain and heart.

Signs and Symptoms of Heart Failure

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Right Ventricular Myocardial Infarction

People who have a myocardial infarction caused by a blockage in the right coronary artery may suffer from damage to the right ventricular muscle, producing right-sided heart failure. Treating a right ventricular heart attack is similar to treating any myocardial infarction, including rapidly opening up the blocked blood vessel with clot-busting drugs or a stent.

However, because right-sided heart failure can limit the amount of blood that reaches the left side of the heart, drugs aimed mainly at treating left-sided ventricular weakness need to be used with great caution in people having right ventricular heart attacks.

Treatment Of Right Sided Heart Failure

We applaud the excellent review on the investigation and managementof congestive heart failure.1 However its noticeable that whilst thefocus of the article was on congestive heart failure, the emphasis waspredominantly on left ventricular failure. The possibility of isolatedright ventricular failure was not highlighted.

It is important to recognize that isolated RVF and Pulmonary Hypertensioncan present as a medical emergency. In many patients diagnosis is delayedas signs and symptoms are confused with biventricular or left ventricularfailure and there is delay in initiating appropriate management.

Tricuspid regurgitation which is often a significant component of thispathology may be silent as the murmur may not be clinically audible andhence early availability of echocardiography cannot be over emphasized.

In RVF loop diuretics are the first line treatment, while there is noclear evidence for the benefit of angiotensin converting enzyme inhibitorsor beta blockers which are essential for optimum management of leftventricular failure.

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Overproduction Of Reactive Oxygen Species

Activated oxidative stress has been demonstrated in animal studies as well as in human studies to cause heart failure also lowered antioxidant activity in failing human hearts promotes oxidative stress . Furthermore, some risk factors for the development of heart failure also show increased oxidative stress i.e., hypertension, diabetes, obesity. Also in myocardial hypertrophy parameters of the redox-sensitive signaling pathways and transcription factors are activated . However, the complete mechanism is not understood yet . There are several factors activated via ROS which may influence contractility: proinflammatory mediators, periods of ischemia, auto-oxidation of catecholamines.

How Does Right Sided Heart Failure Affect The Liver

An Osmosis Video: Congestive Heart Failure (CHF) Explained

They conclude that right-sided heart failure resulting in hepatic venous congestion, may predispose the liver to hepatic injury induced by a hypotensive event. The most presumed causes of car diac induced ALF are hepatic congestion from venous hypertension and decreased oxygen delivery from a decreased CI .

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Does Pulmonary Hypertension Cause Left Or Right Sided Heart Failure

In people who have pulmonary hypertension, changes in the small blood vessels inside the lungs can lead to increased blood pressure in the right side of the heart. This makes it harder for the heart to pump blood to the lungs. If this high pressure continues, it puts a strain on the right side of the heart.

How Common Is Heart Failure

In the United States alone, more than six million adults have been diagnosed with heart failure.

Heart failure is usually divided into two categories based on which side of the heart it mainly affects. The right side of the heart collects oxygen-depleted blood from the body and brings it to the lungs to be filled with fresh oxygen. The left side of the heart receives oxygen-rich blood from the lungs and sends it out to the rest of the body.

While the end result is the same, symptoms can vary based on whether the right or left side of the heart is affected.

Verywell / Jessica Olah

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When To See A Doctor

Its a good idea to speak with your doctor to check your heart health if you:

  • Notice swelling in your legs
  • Become winded easily with normal activities

There is no cure for heart failure. Still, with treatment, you can slow the progression of it and stay feeling better for longer.

You should seek immediate medical attention or call 911 if you or a loved one is experiencing:

  • Sudden shortness of breath, irregular heartbeat, or chest pain
  • Trouble breathing and blood-tinged phlegm
  • Fainting or loss of consciousness

Clinical Characteristics And Evaluation

Congestive heart failure

Clinical characteristics of right-sided HF are caused by increased pressure in the right atrium and reduced left ventricular filling as a result of the effect of ventricular interdependence. Elevated central venous pressure impedes lung lymphatic drainage, so in patients with pulmonary hypertension resulting from left-sided heart diseases, lung fluid clearance decreases and excessive pulmonary edema can lead to pleural effusion.

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What Are The Symptoms Of Heart Failure

The main symptoms of heart failure are:

  • Shortness of breath when youre active or resting, because youre not getting enough oxygen.
  • Swollen feet, ankles, stomach and around the lower back area, caused by fluid build up.
  • Feeling unusually tired or weak because theres not enough blood and oxygen getting to your muscles.

You should see your GP immediately if you begin to experience any of these symptoms.

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Outlook For Heart Failure

Heart failure is a serious long-term condition that will usually continue to get slowly worse over time.

It can severely limit the activities youre able to do and is often eventually fatal.

But its very difficult to tell how the condition will progress on an individual basis.

Its very unpredictable. Lots of people remain stable for many years, while in some cases it may get worse quickly.

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Classification Based On Course Of The Disease

Heart failure can develop suddenly, for instance after a heart attack or due to certain heart rhythm problems. This is known as acute heart failure.

But it usually develops gradually over time as a result of a different medical problem, such as permanently high blood pressure. This is known as chronic heart failure.

Congestive Heart Failure Drugs

Pathophysiology of Congestive Heart Failure (CHF)

There are several medications that can be used to treat CHF, including ACE inhibitors, beta-blockers, and more.

ACE inhibitors

Angiotensin-converting enzyme inhibitors open up narrowed blood vessels to improve blood flow. Vasodilators are another option if you cant tolerate ACE inhibitors.

You may be prescribed one of the following:

voluntary recall of 5 lots of the drug Accupril due to the presence of nitrosamine. Nitrosamine, a known carcinogen with the potential to cause cancer, was found to exist in the drug at levels greater than the Acceptable Daily Intake as determined by the FDA. This recall is specific only to a handful of lot numbers and does not affect all Accupril tablets made by Pfizer. If you take Accupril tablets, talk with your pharmacist or doctor and they will help you determine if your medication has been impacted by the recall.

ACE inhibitors shouldnt be taken with the following medications without consulting a doctor, because they may cause an adverse reaction:

  • Potassium-sparing diuretics and potassium supplements. These diuretics can cause potassium buildup in the blood, which may lead to abnormal heart rhythms. Examples include: riamterene , eplerenone , and spironolactone .
  • Nonsteroidal anti-inflammatory drugs .NSAIDs such as ibuprofen, aspirin, and naproxen, can cause sodium and water retention. This may reduce the ACE inhibitors effect on your blood pressure.

Beta-blockers

This may be achieved with:

Diuretics

Your doctor may recommend:

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When To Get Medical Advice

See a GP if you experience persistent or gradually worsening symptoms of heart failure.

Call 999 for an ambulance or go to your nearest A& E department as soon as possible if you have sudden or very severe symptoms.

A number of tests can be used to help check how well your heart is working, including blood tests, an ECG and an echocardiogram.

Can Heart Failure Be Prevented

You may be able to prevent or delay heart failure if you:

  • Work with your provider to manage any health conditions that increase your risk of developing heart failure
  • Make healthy changes in your eating, exercise, and other daily habits to help prevent heart disease

NIH: National Heart, Lung, and Blood Institute

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Nyha Functional Classification System

The New York Heart Association functional classification considers heart failure symptoms that happen during exercise to determine stage. Patients can go back and forth between stages depending on how well-controlled symptoms are on a given day.

  • Stage 1: The person has heart disease, but it isnt yet causing symptoms or limiting activities.
  • Stage 2: The person has mild symptoms that only slightly limit activity.
  • Stage 3: The person has significant limitations to activities. He or she is only comfortable when resting.
  • Stage 4: The person has major limitations and experiences symptoms when at rest.

Pathophysiologic Characteristics: How Rv Dysfunction Occurs In Left

Category: Nursing Mnemonics

The right ventricle is a low-resistance and high-compliance chamber that maintains stroke volume and cardiac output according to venous return, resulting in a particular sensitivity to acute changes in RV afterload.9 It has been demonstrated that around 70% of patients with HF demonstrate RV dysfunction, which arises as a consequence of a series of mechanisms, primarily identified in an increased vascular impedance (ie, elevated left atrial pulsatile loading, superimposed pulmonary vascular

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Heart Failure During Covid

Your heart failure nurse might have been redeployed, making it hard to have in-person appointments or check-ups. âThe key thing is to look after yourself well, and always phone your GP or heart failure team if your symptoms change or worsen,â says BHF nurse Lucy Martin. âIn fact, call your GP or heart failure team if you have any concerns about your medication or care â they are there to help you.â

Your GP is qualified to answer any questions you might have. Dont worry about wasting their time this is exactly what theyre there for.

Optimisation Of Rv Preload Afterload And Contractility

Preload optimisation

Critically ill patients may have reduced right heart preload due to volume loss, reduced venous tone from medications, sepsis or vasoplegia, and positive pressure ventilation. Although the Frank-Starling mechanism is preserved in the failing human RV myocardium , the right ventricle has a much flatter Frank-Starling curve than the left ventricle, and therefore RV contractility changes less over a wide range of filling pressures. In conditions where RV output is impaired due to contractile dysfunction but the afterload is normal , a higher preload is needed to maintain forward flow. However, the majority of conditions leading to RHF are characterised by high RV afterload. In these scenarios, reducing excessive RV preload with diuretics or haemofiltration is key to reducing RV dilatation and free wall tension, thereby minimising RV ischaemia and optimising contractility. It is generally agreed that maintaining a moderately high RV diastolic filling pressure of 8-12 mmHg is optimal in RHF. However, the goal of maintaining forward flow may be achievable at more normal filling pressures in individual cases.

Afterload reduction

Improving contractility

Concerning inotropes, in animal models low-dose dobutamine has been shown to restore RV-pulmonary artery coupling and cardiac output better than norepinephrine because of its more pronounced inotropic effect . Given that it is an inodilator, it is preferably used in normotensive patients.

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Systolic And Diastolic Failure

Systolic and diastolic heart failure each result in a decrease in stroke volume. This leads to activation of peripheral and central baroreflexes and chemoreflexes that are capable of eliciting marked increases in sympathetic nerve traffic.

Although there are commonalities in the neurohormonal responses to decreased stroke volume, the neurohormone-mediated events that follow have been most clearly elucidated for individuals with systolic heart failure. The ensuing elevation in plasma norepinephrine directly correlates with the degree of cardiac dysfunction and has significant prognostic implications. Norepinephrine, while directly toxic to cardiac myocytes, is also responsible for a variety of signal-transduction abnormalities, such as downregulation of beta1-adrenergic receptors, uncoupling of beta2-adrenergic receptors, and increased activity of inhibitory G-protein. Changes in beta1-adrenergic receptors result in overexpression and promote myocardial hypertrophy.

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Treatment Of Heart Failure Congestive In Dogs

Right Sided Heart Failure Congestive Nursing KAMP 2020

Dogs with moderate to severe problems may need to be hospitalized until the condition is stabilized. Taps will be inserted to remove fluid from the abdomen and around the heart . Strong diuretics, such as furosemide, may be injected to further encourage fluid elimination, and dogs may need additional oxygen.

Once the immediate attack is stabilized, long-term medications will be prescribed to help to control symptoms. Diuretics and ace inhibitors are the most common medications used to reduce fluid build-up and improve blood flow. Pimobendan can increase the force of the hearts contractions, and digoxin may be prescribed if your dogs heart rate is very fast. Beta-blockers and calcium blockers could also be suggested depending on your dogs condition. Most treatment plans will combine a number of different medications.

Other treatment will focus on eliminating the problem that is causing CHF. If your dog has heartworm, it can be treated with medication once your dogs symptoms are stabilized. Some conditions, like atrial septal defect, can be treated with surgery. Others cannot. Valve replacement is only done very rarely in dogs, so problems that affect the valves are often only untreatable symptomatically.

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