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.
History And Physical Exam
A clinician listens to your heart and lungs and measures your blood pressure and weight. They will also ask about your:
- Familys medical history, especially previous cardiac problems
- Medications, including prescriptions, over-the-counter drugs and supplements
- Personal medical history
Blood tests can measure several things related to heart failure:
- Sodium and potassium levels
- Creatinine, which helps measure how well your kidneys are working
- B-type natriuretic peptide , a hormone released from the ventricles in response to increased wall tension that occurs with heart failure
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
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What Are The Symptoms Of Right
The main sign of right-sided heart failure is fluid buildup. This buildup leads to swelling in your:
- Feet, ankles and legs.
- Gastrointestinal tract and liver .
Other signs include:
Where you accumulate fluid depends on how much extra fluid and your position. If youre standing, fluid typically builds up in your legs and feet. If youre lying down, it may build up in your lower back. And if you have a lot of excess fluid, it may even build up in your belly.
Fluid build up in your liver or stomach may cause:
- Appetite loss.
Once right-sided heart failure becomes advanced, you can also lose weight and muscle mass. Healthcare providers call these effects cardiac cachexia.
Other Causes Of Heart Failure
Pulmonary hypertension and heart failure
Heart failure can be caused by pulmonary hypertension . This condition can damage the right side of your heart, leading to heart failure. In some cases, the pulmonary hypertension itself is caused by an existing heart condition.
- Find out more about pulmonary hypertension on NHS Choices and PHA UK.
Amyloidosis happens when abnormal proteins, called amyloid, build up in organs and tissues. This affects how your organs work. If amyloidosis affects the heart it’s called cardiac amyloidosis or stiff heart syndrome and can lead to heart failure.
- Read more about amyloidosis treatment.
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What Is Heart Failure
Although the term heart failure suggests your heart isnt able to function at all, it actually means your heart muscles just arent functioning well enough to support your bodys needs. It develops when your heart muscles are either too weak or not elastic enough to pump blood properly. About 6.2 million people in the United States are living with heart failure.
Heart failure is usually a chronic and progressive condition, but it can develop quickly after a heart attack or other conditions that damage your heart. The most common cause of heart failure is coronary artery disease, which is a narrowing of the arteries that supply blood to your heart.
Heart Failure During Covid
Your heart failure nurse might have been redeployed, making it hard to have in-person appointments or check-ups. ‘The key thing is to look after yourself well, and always phone your GP or heart failure team if your symptoms change or worsen,’ says BHF nurse Lucy Martin. ‘In fact, call your GP or heart failure team if you have any concerns about your medication or care – they are there to help you.’
Your GP is qualified to answer any questions you might have. Dont worry about wasting their time this is exactly what theyre there for.
- Find out more about coronavirus and how it affects people with heart conditions at our coronavirus support hub.
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Treatments For Heart Failure
Treatment for heart failure usually aims to control the symptoms for as long as possible and slow down the progression of the condition.
How you’re 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.
When Should I See A Healthcare Provider About Right Heart Failure
If you have chest pains or suspect you may be having a heart attack, call 911 or go to the nearest emergency room.
Get in touch with your healthcare provider if you experience:
- Shortness of breath.
What else should I ask my provider?
If you have right-sided heart failure, ask your provider:
- What treatment is best for me?
- Is there a special diet I should follow?
- Should I go to cardiac rehab?
- Will I need surgery?
- Will I need a heart transplant?
- What can I do to stop heart failure from progressing?
- What medications will I need?
A note from Cleveland Clinic
Right-sided heart failure means the right side of the heart can no longer pump blood efficiently. Fluid builds up in tissues, causing swelling. Treatment focuses on managing symptoms so the disease doesnt worsen. Healthy lifestyle habits, along with cardiac rehab, improve symptoms for many people. Other treatment options include cardiac devices and surgery. If you have shortness of breath, swelling or chest discomfort, talk to your healthcare provider.
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The Flow Of Blood Through Your Heart
To understand the different types of heart failure, it helps to know how your heart pumps blood:
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.
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Atrial Natriuretic Peptide And B
ANP and BNP are endogenously generated peptides activated in response to atrial and ventricular volume/pressure expansion. ANP and BNP are released from the atria and ventricles, respectively, and both promote vasodilation and natriuresis. Their hemodynamic effects are mediated by decreases in ventricular filling pressures, owing to reductions in cardiac preload and afterload. BNP, in particular, produces selective afferent arteriolar vasodilation and inhibits sodium reabsorption in the proximal convoluted tubule. It also inhibits renin and aldosterone release and, therefore, adrenergic activation. ANP and BNP are elevated in chronic heart failure. BNP especially has potentially important diagnostic, therapeutic, and prognostic implications.
For more information, see the Medscape Drugs & Diseases article Natriuretic Peptides in Congestive Heart Failure.
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.
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What Causes Heart Failure
There are lots of reasons why you may have heart failure. It can be sudden or it can happen slowly over months or years.
The most common causes of heart failure are:
- a heart attack which can cause long-term damage to your heart, affecting how well the heart can pump.
- high blood pressure – putting strain on the heart, which over time can lead to heart failure.
- cardiomyopathy – a disease of the heart muscle. There are different types which can either be inherited or caused by other things, such as viral infections or pregnancy.
Heart failure can also be caused by:
Heart Failure Signs And Symptoms
By themselves, any one sign of heart failure may not be cause for alarm. But if you have more than one of these symptoms, even if you haven’t been diagnosed with any heart problems, report them to a healthcare professional and ask for an evaluation of your heart. Congestive heart failure is a type of heart failure which requires seeking timely medical attention, although sometimes the two terms are used interchangeably.
This table lists the most common signs and symptoms, explains why they occur and describes how to recognize them.
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Types Of Heart Failure
divides heart failure into one of three categories based on the part of your heart thats affected:
- Diastolic failure. This means your left ventricle doesnt relax properly due to stiffness and your heart doesnt fill with enough blood between beats, or the pressure for the heart to function is very high.
- shortness of breath when lying down
- sleeping on extra pillows at night
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.
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What Do The Left And Right Sides Of The Heart Do
The two sides of your heart work in different ways to pump blood.
- Left side: Receives oxygen-rich blood from your lungs and delivers it to the rest of your body. The oxygen helps organs, muscles and other tissue do their job.
- Right side: Receives oxygen-poor blood from your body and delivers it to your lungs. From there, you release carbon dioxide and take in more oxygen.
What Are The Current Treatment Options
The proper treatment for right-sided heart failure depends on the underlying condition causing it. Treating right-sided heart failure usually involves using one or more medications, lifestyle measures, and possibly implanted devices that support the hearts ability to pump. Treating left-sided heart failure is also important.
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How Is Heart Failure Diagnosed
Your doctor will ask about your medical history, symptoms and examine you. You may then be sent for tests such as:
- an echocardiogram
- breathing tests to see if a lung problem is causing your breathlessness
- a chest x-ray to check if there’s fluid in your lungs or if a lung condition is causing the symptoms.
Your doctor may talk about the ejection fraction of your heart. This refers to the amount of blood that is squeezed out of your left ventricle every time your heart beats. Its usually measured as a percentage over 50% is considered normal. Your ejection fraction is measured from an echocardiogram.Some people with heart failure can have a normal ejection fraction, so ejection fraction is used alongside other tests to diagnose heart failure.
The Ticker Tapes Podcast
Claire Berouche’s life changed in ways she could never have imagined following a family afternoon at the cinema. Claire was given the shock news that she had suffered a heart attack and subsequently heart failure which is irreversible. Hear her story and other real experiences from people living with heart and circulatory diseases.
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Whats The Outlook For People With Right
For many people, the right combination of therapies and lifestyle changes can slow or stop the disease and improve symptoms. They can lead full, active lives.
About 1 in 10 American adults who live with heart failure have advanced heart failure. That means treatments arent working, and symptoms are getting worse. You may feel symptoms, such as shortness of breath, even when youre sitting. If you have advanced heart failure, talk with your care team about important care decisions and next steps.
Precipitating Causes Of Heart Failure
A previously stable, compensated patient may develop heart failure that is clinically apparent for the first time when the intrinsic process has advanced to a critical point, such as with further narrowing of a stenotic aortic valve or mitral valve. Alternatively, decompensation may occur as a result of the failure or exhaustion of the compensatory mechanisms but without any change in the load on the heart in patients with persistent, severe pressure or volume overload. In particular, consider whether the patient has underlying coronary artery disease or valvular heart disease.
The most common cause of decompensation in a previously compensated patient with heart failure is inappropriate reduction in the intensity of treatment, such as dietary sodium restriction, physical activity reduction, or drug regimen reduction. Uncontrolled hypertension is the second most common cause of decompensation, followed closely by cardiac arrhythmias . Arrhythmias, particularly ventricular arrhythmias, can be life threatening. Also, patients with one form of underlying heart disease that may be well compensated can develop heart failure when a second form of heart disease ensues. For example, a patient with chronic hypertension and asymptomatic LV hypertrophy may be asymptomatic until an MI develops and precipitates heart failure.
- Profound anemia
- Nutritional deficiencies
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Left Sided Heart Failure
primary cause of right sided heart failure.
When the left ventricle is not working as effectively, fluid pressure increases and ends up moving back through the lungs. This can cause an overload to the heartâs right side.
Consequently, when the right side is unable to pump blood, fluid accumulates in the veins, resulting in swelling.
What Is Congestive Heart Failure In Cats
Congestive heart failure is a term that refers to the heart’s inability to pump enough blood to the body. Due to this, blood starts to back up into the lungs and fluid accumulates in the chest, abdomen, or both. This lead to further constriction of the heart and lungs, and limits oxygen flow throughout the body. There are many causes of CHF in cats, but the two most common causes are:
- Mitral valve insufficiency , which refers to a leaky mitral valve, which is the valve between the left atrium and the left ventricle.
- Dilated cardiomyopathy , which is when the heart chambers enlarge and lose their ability to contract.
Clinical signs of CHF vary depending on whether the cat has left- or right-sided heart failure.
Right-sided congestive heart failure
This occurs when a heart contraction causes some blood to leak into the right atrium from the right ventricle rather than being pushed through the lungs and becoming oxygenated. As a result, the main circulation system becomes congested with blood, and fluid accumulates in the abdomen, interfering with adequate organ function. Excess fluid might also build up in the limbs and cause swelling known as peripheral edema.
Left-sided congestive heart failure
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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.