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Which Of The Following Signs Is Commonly Observed In Patients With Right-sided Heart Failure

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What Are The Signs And Symptoms Of Congestive Heart Failure

Right heart failure, clinical signs and symptoms

Shortness of breath

The hallmark and most common symptom of left heart failure is shortness of breath and may occur.

  • While at rest
  • While lying flat
  • While awakening the person from sleep ; or
  • Due to fluid accumulation in the lungs or the inability of the heart to be efficient enough to pump blood to the organs of the body when called upon in times of exertion or stress.
  • Chest Pain

  • Chest pain or angina may be associated, especially if the underlying cause of the failure is coronary heart disease.
  • Right heart failure, left heart failure, or both

  • People with right heart failure leak fluid into the tissue and organs that deliver blood to the right heart through the vena cava.
  • Backpressure in capillary blood vessels causes them to leak water into space between cells and commonly the fluid can be found in the lowest parts of the body.
  • Gravity causes fluid to accumulate in the feet and ankles but as more fluid accumulates, it may creep up to involve all of the lower legs.
  • Fluid can also accumulate within the liver causing it to swell and within the abdominal cavity .
  • Ascites and hepatomegaly may make the patient feel bloated, nauseated, and have abdominal pain with the feeling of distension.
  • Depending upon their underlying illness and the clinical situation, patients may have symptoms of right heart failure, left heart failure, or both.
  • What Is The Long

    The long-term outlook depends on how quickly the diagnosis can be made, the underlying cause of the tamponade, and any subsequent complications. Your outlook is fairly good if the cardiac tamponade is quickly diagnosed and treated.

    Your long-term outlook greatly depends on how quickly you get treatment. Seek medical treatment immediately if you think you have this condition.

    How Is Cardiac Tamponade Treated

    Cardiac tamponade is a medical emergency that requires hospitalization. The treatment of cardiac tamponade has two purposes. It should relieve pressure on your heart and then treat the underlying condition. Initial treatment involves your doctor making sure youre stabilized.

    Your doctor will drain the fluid from your pericardial sac, typically with a needle. This procedure is called pericardiocentesis. Your doctor may perform a more invasive procedure called a thoracotomy to drain blood or remove blood clots if you have a penetrating wound. They may remove part of your pericardium to help relieve pressure on your heart.

    Youll also receive oxygen, fluids, and medications to increase your blood pressure.

    Once the tamponade is under control and your condition stabilizes, your doctor may perform additional tests to determine the underlying cause of your condition.

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    Clinical Features Of Right Heart Failure

    This was the topic of;Question 2;from the second paper of 2015, where 20% of the total mark were attributed to four features of right heart failure. As a disease process typically associated with many concomitant problems and flow-on effects, it is hard to separate the clinical features of right heart from the clinical features of left heart failure or pulmonary hypertension . The situation is made more complex by a lack of any single definitive resource. Resorting to Talley & O’Connor, one finds a list which is reproduced here mainly because the source was so influential during the formative period of many of the examiners.

    This list has the merit of being focused on the examination findings in the same order in which they are found during a routine cardiovascular examination, which favours application to the scenario of the CICM hot case. Another way of organising these might be according to their pathophysiological relationship, as below:

    • Features attributable to pulmonary hypertension
    • Loud P2
    • Ascites
    • Hepatomegaly
    • Signs of LV failure, eg. pulmonary oedema

    Armed with a stethoscope and the aboveslisted information, one might feel confident about being able to make an assessment of right heart failure clinically, but how reliable is that, really? For logistic;reasons, the answer has been pushed under the next <h2>.

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    Pulmonary Embolism in Heart Failure

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    Point Of Maximal Impulse

    The point of maximal impulse of the left ventricle is usually located in the midclavicular line at the fifth intercostal space. With the patient in a sitting position, the physician uses fingertips to identify this point. Cardiomegaly usually displaces the cardiac impulse laterally and downward.

    At times, the point of maximal impulse may be difficult to locate and therefore loses sensitivity . Yet the location of this point remains a specific indicator for evaluating the size of the heart.14

    Is Chf Due Mainly To Heart Valve Disease

    CHF is most commonly caused by valvular insufficiency. It is estimated that 80% of the canine CHF cases are caused by MVI. However, there are many other causes. Disease of the heart muscle , irregularities of rhythm, and narrowing of some of the major blood vessels can also cause CHF. Initially, MVI results in left-sided congestive heart failure. If left untreated, the heart failure may progress to involve both sides of the heart.

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    Liver Size And Hepatojugular Reflux

    The key component of the abdominal examination is the evaluation of liver size. Hepatomegaly may occur because of right-sided heart failure and venous congestion.

    The hepatojugular reflux can be a useful test in patients with right-sided heart failure. This test should be performed while the patient is lying down with the upper body at a 45-degree angle from the horizontal plane. The patient keeps the mouth open and breathes normally to prevent Valsalva’s maneuver, which can give a false-positive test. Moderate pressure is then applied over the middle of the abdomen for 30 to 60 seconds. Hepatojugular reflux occurs if the height of the neck veins increases by at least 3 cm and the increase is maintained throughout the compression period.18

    Continue Learning About Heart Failure Symptoms

    Congestive Heart Failure (CHF) Treatment, Management, Nursing Interventions & Medications Part 2

    Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.

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    What Is The Prognosis And Life Expectancy For Congestive Heart Failure

    • The degree to which other organ systems are involved and the severity of other accompanying conditions
    • The person’s symptoms and degree of impairment
    • Other factors that remain poorly understood

    With the availability of newer drugs to potentially favorably affect the progression of the disease, the prognosis in congestive heart failure is generally more favorable than that observed just 10 years ago. In some cases, especially when the heart muscle dysfunction has recently developed, a significant spontaneous improvement is not uncommonly observed, even to the point where heart function becomes normal.

    Heart failure is often graded on a scale of I to IV based on the patient’s ability to function.

  • Class I includes patients with a weakened heart but without limitation or symptoms.
  • Class II describes patients whose only limitation is heavier workloads.
  • Class III includes patients who experience limitations with everyday activity.
  • Class IV describes patients with severe symptoms at rest or with any degree of effort.
  • The prognosis of heart failure patients is very closely associated with the functional class.

    An important issue in congestive heart failure is the risk of heart rhythm disturbances . Of those deaths that occur in individuals with congestive heart failure, approximately 50% are related to progressive heart failure. Importantly, the other half are thought to be related to serious arrhythmias.

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    What Are The Causes

    Mechanism of Progressive Heart Failure and Significance of ...

    Sometimes it just happens. But usually itâs left-side heart failure that causes right-side heart failure. As the left chamber of your heart loses some of its ability to pump, blood continues to back up — sometimes into your lungs.

    Heart failure is a long-term condition that gets worse over time. In most cases, you get it because you have other health issues that have damaged or weakened your heart.

    Some other causes of right-side heart failure include:

    Coronary artery disease. This is the most common form of heart disease and cause of heart failure. When you have coronary artery disease, plaque blocks your arteries, causing blood flow to your heart muscle to slow or even stop. Read more on clogged arteries and the causes of arterial plaque.

    High blood pressure. It measures how hard your heart pumps blood through your arteries. The higher your blood pressure, the harder your heart is working to pump it. That means over time, your heart muscles can thicken and weaken because of the extra work they do. Learn about the symptoms of high blood pressure.

    Damaged heart valves. Valves keep blood flowing in the right direction through your heart. If they get damaged, by an infection or heart defect, for instance, your heart has to work harder to pump blood. Eventually, it will become weakened. Get more information on heart valve disease symptoms and causes.

    Also Check: What’s Resting Heart Rate

    What Procedures And Tests Diagnose Congestive Heart Failure

    Congestive heart failure can be a medical emergency, especially if it acutely decompensates and the patient can present extremely ill with the inability to breathe adequately. In this situation, the ABCs of resuscitation need to be addressed while at the same time, the diagnosis of congestive heart failure is made.

    Common tests that are done to help with the diagnosis of congestive heart failure include the following:

    • Electrocardiogram to help assess heart rate, rhythm, and indirectly, the size of the ventricles and blood flow to the heart muscle.
    • Blood tests may include a complete blood count , electrolytes, glucose, BUN, and creatinine .
    • B-type natriuretic peptide may be helpful in deciding if a patient has shortness of breath from congestive heart failure or from a different cause. It is a chemical that is located in the heart ventricles and may be released when these muscles are overloaded.
    • Echocardiography or ultrasound testing of the heart is often recommended to assess the anatomy and the function of the heart. In addition to being able to evaluate the heart valves and muscle, the test can look at blood flow within the heart, watch the chambers of the heart contract, and measure the ejection fraction .

    Other tests may be considered to evaluate and monitor a patient with suspected congestive heart failure, depending upon the clinical situation.

    Heart Failure In Children

    In children, manifestations of heart failure vary with age. Signs of pulmonary venous congestion in an infant generally include tachypnea, respiratory distress , grunting, and difficulty with feeding. Often, children with heart failure have diaphoresis during feedings, which is possibly related to a catecholamine surge that occurs when they are challenged with eating while in respiratory distress.

    Right-sided venous congestion is characterized by hepatosplenomegaly and, less frequently, with edema or ascites. Jugular venous distention is not a reliable indicator of systemic venous congestion in infants, because the jugular veins are difficult to observe. Also, the distance from the right atrium to the angle of the jaw may be no more than 8-10 cm, even when the infant is sitting upright. Uncompensated heart failure in an infant primarily manifests as a failure to thrive. In severe cases, failure to thrive may be followed by signs of renal and hepatic failure.

    In older children, left-sided venous congestion causes tachypnea, respiratory distress, and wheezing . Right-sided congestion may result in hepatosplenomegaly, jugular venous distention, edema, ascites, and/or pleural effusions. Uncompensated heart failure in older children may cause fatigue or lower-than-usual energy levels. Patients may complain of cool extremities, exercise intolerance, dizziness, or syncope.

    For more information, see the Medscape Drugs & Diseases article Pediatric Congestive Heart Failure.

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    Chest Pain/pressure And Palpitations

    Chest pain/pressure may occur as a result of either primary myocardial ischemia from coronary disease or secondary myocardial ischemia from increased filling pressure, poor cardiac output , or hypotension and hypoxemia.

    Palpitations are the sensation a patient has when the heart is racing. It can be secondary to sinus tachycardia due to decompensated heart failure, or more commonly, it is due to atrial or ventricular tachyarrhythmias.

    What Causes Congestive Heart Failure

    Heart Failure/Chest Pain

    There are several conditions that can impair the pumping efficiency of the heart. Below are a few common and rare conditions that can cause congestive heart failure:

    • Coronary artery disease : This is the most common cause of congestive heart failure, as the arteries become blocked or severely narrowed, which decreases blood flow to the heart.
    • Alcohol abuse
    • Disorders of heart valves
    • Thyroid abnormalities, viral infection, and heart rhythm abnormalities are a few rare cases that can cause 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.

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