Acute Right Ventricular Heart Failure

Right-sided heart failure is a chronic pathology. It occurs with dysfunction of the heart muscles in the right myocardium. If symptoms occur, the patient needs emergency medical attention. Those who know the signs of a dangerous disease immediately turn to the therapist.

The classification of pathology depends on the place of its localization. There are 2 types of heart failure:

  • right ventricular (pulmonary heart);
  • left ventricular.
Type of diseaseLocationCausesAftermath
Left ventricularIt affects the left side of the myocardium.It is caused by a decrease in coronary circulation, infectious diseases, tachycardia, arrhythmia.The left ventricle is overloaded. In the pulmonary circle, blood circulation forms stagnation. Causes cardiac asthma, pulmonary edema, cardiogenic shock.
Right ventricularThe functioning of the right myocardium is disrupted.It manifests itself in pulmonary thromboembolism, lingering asthma, bilateral pneumonia, pulmonary heart, pericarditis.The right ventricle is overloaded. Stagnation occurs in a large circle of blood circulation. Blood fills organs in abundance, but hardly leaves them. The liver grows, legs swell, cyanosis occurs, life-threatening complications develop in the lungs.

There are 2 forms of pathology:

  • chronic;
  • acute right ventricular failure.

Right-sided failure is a secondary disease. It is preceded by left ventricular heart failure. In most patients, right ventricular and left-sided insufficiency occur together. But there are cases where heart failure on the right occurs in isolation.

In the early stages, the symptoms of the disease are due to congestion in the pulmonary circulation. Right ventricular failure is accompanied by:

  • tachycardia (spontaneous increase in heart rate);
  • arterial hypotension (steady decrease in pressure);
  • shortness of breath, lack of air;
  • pressing pains in the region of the heart;
  • swelling of the limbs;
  • low temperature of the skin (cold hands and feet);
  • cyanosis (skin in the region of the nasolabial triangle, arms and legs become cyanotic);
  • reduced turgor of the skin;
  • swelling and pulsation of the jugular veins (lying down);
  • high vascular permeability;
  • pulmonary edema;
  • nausea-vomiting syndrome;
  • fainting
  • weakness, fatigue.

These symptoms are unchanged at all stages of the development of pathology. When right ventricular heart failure goes into complicated forms, they are exacerbated. Symptoms of stagnant blood in a large circle of blood circulation are connected to them.

Patients suffer from:

  • Feelings of heaviness and pain in the right hypochondrium arising from swelling of the liver.
  • Hypertension.
  • Swelling.
  • Oliguria – impaired blood flow in the kidneys.
  • Decreased urine production caused by fluid retention.
  • Cardiac asthma, triggered by excess blood in the venous vessels and capillaries of the lungs.
  • Expansion and swelling of the cervical veins lying and sitting.
  • Mental disorders caused by impaired outflow of venous blood from the brain and oxygen starvation.
  • Gastritis and other diseases of the digestive system.
  • Loss of appetite and weight.
  • Ascites (excessive accumulation of fluid in the abdomen).
  • Hydrothorax (fluid effusion in the chest).

Location of edema

Swelling is the first sign of right-sided heart failure. Edema is formed in organs distant from the heart:

  1. First of all, puffiness affects the lower extremities. First, the region of the ankle joint swells. Then the legs and hips are involved in the pathological process.
  2. In severe forms of the disease, edema, rising up the body, spreads along the abdominal wall.
  3. In men, swelling of the scrotum is noted.
  4. The hands, chest and neck are drawn into the process.
  5. Swelling of the abdomen (ascites), chest cavity (hydrothorax) develops.
  6. There is pulmonary edema.

When the pressure in the left atrium and pulmonary capillaries rises to critical values, the fluid begins to leak through the vascular walls. It fills the pulmonary vesicles and lumens.

With pulmonary edema, dyspnea develops into suffocation. The patient becomes agitated, assumes a forced sitting position, which brings relief. The skin turns pale, the mucous membranes acquire a cyanotic (purple) hue.

The jugular veins swell. Tachycardia or arrhythmia develops. Intense cough is accompanied by the separation of foamy sputum with blood inclusions. When listening, moist rales of various types are found. The doctor differentiates pulmonary edema from bronchial asthma. With its development, urgent diagnosis and immediate treatment is required.

At the beginning of the development of pathology, the legs and other parts of the body swell by the end of the day. Late puffiness becomes a sustainable phenomenon. It spreads throughout the body, causing anasarzi.

Fluid builds up in the heart bag and abdominal cavity, leading to the formation of a “frog stomach”. At the same time, up to 1,5-2 liters of edematous fluid is collected in the stomach.

Hydrothorax is a life-threatening complication. When 1 liter of fluid enters the pleura, the lungs contract, breathing is difficult, hypoxia and suffocation occur. Without emergency medical care, the patient has no chance of survival.

According to the severity of signs, the disease was divided into 3 stages. Each of them has its own symptomatology.

Legs swell. The patient suffers from shortness of breath and palpitations even at rest. There are 2 phases:

  • Dyspnea is caused by minor loads. There is a dry cough, moist rales are noted, hemoptysis periodically occurs. Heart rate is disturbed. Swelling and swelling of the liver are not significant. Performance is greatly reduced.
  • Signs of the disease worsen. Shortness of breath and swelling are constantly present. Pain lasts a long period of time. There are interruptions in the work of the heart, the liver is enlarged. Patients lose their ability to work.
StageSymptoms
InitialWith physical activity, shortness of breath occurs, the heart rate increases. At rest, the pathology is asymptomatic.
Average
TerminalA severe incurable form of the disease, in which irreversible pathological transformations occurred in various organs. There is a violation of metabolic processes leading to exhaustion.
PowerEvidence
IPasses hidden, without external signs.
IIThe appearance of wheezing is noted.
IIIThe number of wheezing is increasing.
IVPressure drops to critical levels. Cardiogenic shock develops.

First aid in acute form

An exacerbation of the disease is caused by pathologies that unexpectedly limit the freedom of movement of blood flow in the pulmonary circulation.

The main factors provoking the development of the acute form of the disease include:

  • protracted, severely ongoing asthmatic conditions;
  • pulmonary embolism;
  • blockage of the trachea or bronchi by a foreign body;
  • pneumomediastinum;
  • concentration of air in the pleural cavity;
  • bilateral drain pneumonia;
  • subsidence of the alveoli;
  • effusion in the chest cavity;
  • respiratory distress in infants;
  • any pathologies that are accompanied by acute respiratory failure.

Acute right ventricular failure is formed with heart defects with decreased pulmonary circulation. Its appearance provokes a procedure for transfusion of citrate blood, which is performed quickly without introducing calcium and novocaine.

It develops when hypertonic injections or contrast agents intended for x-ray examination, when administered intravenously, infuse instantly. Accelerated administration of drugs causes increased resistance and spasm of blood vessels related to the pulmonary circulation.

The acute form of right-sided heart failure is accompanied by the following symptoms:

  • swelling on the legs;
  • shortness of breath;
  • suffocate;
  • cyanosis;
  • sinus tachycardia;
  • bloating of veins on the neck;
  • strong pulsation of the internal jugular vein;
  • enlarged liver;
  • the occurrence of pain in the right hypochondrium;
  • disturbed heart rhythm;
  • out of breath;
  • tightness behind the sternum;
  • heartache;
  • the appearance of cold sweat on the skin;
  • expansion of the right ventricle;
  • weak pulse;
  • an increase in central venous pressure;
  • tachycardia.

An exacerbation develops suddenly. When it appears, the signs of the disease dominate, which provoked the occurrence of right-sided heart failure.

Acute congestive manifestations that arose in a large circle of blood circulation lead to renal failure. Blood biochemistry indicates impaired functioning of the liver and kidneys.

Sometimes, blood pressure drops sharply in patients, which causes shock. Due to poor blood circulation, cyanosis appears on the skin of the limbs.

If signs of exacerbation occur, urgently need to call an ambulance. The rapid development of pathology ends with an irreversible process in the body – pulmonary edema. It is possible to avoid a fatal outcome if the doctor promptly provides medical assistance to the patient.

A heart muscle has a pumping function, when its work is disrupted, heart failure develops. Every year, young people are diagnosed with this problem more often.

As a result of the disease, blood flow to organs and tissues is disrupted, due to which there is a lack of nutrients and oxygen starvation. For this reason, their work is disrupted, and serious complications arise.

With left ventricular failure, it is the left parts of the heart that are overloaded and affected. In the lungs, congestive processes are observed, which is expressed in shortness of breath, swelling and attacks of bronchial asthma.

With this pathology, a large-scale vascular lesion and a weakening of the myocardium are observed. The development of this condition occurs under the influence of many factors, including acute heart attack, anemia, fever and others.

This condition requires urgent treatment, as it can lead to the death of the patient.

In the case of an acute attack, the help of doctors is necessary, since it can lead to death. Before the arrival of doctors you need:

  1. Place the patient in a sitting position, and lower the legs from the bed down. In no case should you lie, this will only aggravate the situation.
  2. Provide fresh air to the room.
  3. Give a tablet of nitroglycerin under the tongue.

If a person has medical skills, in case of acute pain, Morphine is administered under the skin. A sharp decrease in pressure leads to pulmonary edema, therefore, to eliminate it, 5 ml of prednisolone is needed.

In the absence of drugs or skills, it is necessary to stop the flow of blood to the arms and legs. For this, braids are applied to the shoulders and hips. The patient is hospitalized for further treatment. During transportation to a medical facility, he should sit on a stretcher.

Causes of

The occurrence of acute left ventricular failure can occur in people of any age. The chances of this increase in the presence of other pathologies of the cardiovascular system and after 50 years.

Most often, such a diagnosis is made for older men suffering from coronary artery disease.

Cardiological causes of left ventricular failure are considered diseases in the form of:

  1. Myocardial infarction and subsequent tissue necrosis. The development of the disease occurs with extensive transmural infarction. The patient in this case is in serious condition and the consequences can be provoked depending on the degree of damage.
  2. Myocarditis. These are inflammatory processes in the tissues of the heart.
  3. Congenital and acquired defects that disrupt the architectonics of the heart.
  4. Atrial fibrillation, ventricular tachyarrhythmias.
  5. Hypertensive crisis, in which the pressure in the arteries reaches high numbers.

The development of left ventricular failure is also promoted by some pathologies of other organs and systems. The disease may occur due to:

  1. Thromboembolism. In this case, the pulmonary artery is clogged by a thrombus in the presence of significant damage to the vessel.
  2. Pneumonia.
  3. Acute intoxication with various substances.
  4. Anemia
  5. Electric shock shock.
  6. Asphyxia.
  7. Severe chest injuries.
  8. Pathologies of the kidneys, liver in the terminal stage.

There are also certain factors that influence the likelihood of developing left ventricular failure. A disease occurs if a person has heart pathologies, and he is subjected to excessive physical and emotional overload, visits baths and saunas, abuses alcohol, smokes.

Therefore, it is important to monitor the state of your heart and try to avoid the influence of such factors, since under their influence acute left ventricular failure develops.

Treatment

The technique chosen by the attending physician will be based on the cause of the heart failure. There are a number of drugs that are aimed at restoring the contractile function of the myocardium and at reducing symptoms. If drug therapy did not bring the expected results, the patient is prepared for surgery as planned.

Therapy of heart failure of the right ventricular type should be prescribed by a cardiologist only after a thorough diagnosis of the patient. Many symptoms and clinical manifestations do not allow the use of certain groups of drugs. For example, with venous congestion in a large circle, with enlarged liver, shortness of breath, swelling of the cervical veins, taking drugs belonging to the group of diuretics and vasodilators is contraindicated.

Only weak diuretics are used in the treatment at the minimum dosage prescribed by the doctor. Vasodilators can not be used, because they reduce cardiac output, which further aggravate the pathology.

After taking some drugs, the patient observed refractory hypotension. in this case, intra-aortic counterpulsation, dopamine infusion, and auxiliary blood circulation are applicable. In the same case, plasma or plasma substitutes are administered along with dobutamine and arterial vasodilator to increase the preload on the right ventricle.

Right ventricular failure is a pathology that requires proper treatment and strictly medical supervision. Knowledge of symptoms, timely access to a doctor and therapy are factors that prolong the life of patients, allowing them to return to their usual lives.

Classification

Pathology can occur in acute or chronic form.

Acute left ventricular failure is a condition that requires emergency medical attention. At the same time, the patient suffers from sudden stagnation of blood in the lungs, it flows through thin capillaries, enters the connective tissue of the organ, and from it into the alveoli, in which the air should be in a normal state. If blood gets into them, then normal gas exchange becomes impossible and a person suffocates.

The development of the chronic stage occurs gradually. A person can suffer from a problem for years. Her clinical picture is not as pronounced as in the case of the acute form, but the patient often has attacks of cardiac asthma, in which pulmonary edema is possible.

Therefore, in chronic insufficiency, there is also a risk to the life of the patient in the absence of timely treatment. If you do not carry out maintenance therapy, then gradually the heart will cease to fulfill its functions.

Function classCharacterization
1FKThere are no restrictions on physical activity. The patient suffered or has a heart disease (myocardial infarction, angina pectoris, cardiomyopathy, valvular heart disease, etc.), however, he does not have signs of heart failure (palpitations, shortness of breath, weakness, lightheadedness) both at rest and during normal physical exertion
PFCModerate restriction of physical activity. The patient feels comfortable at rest, but during normal exercise, symptoms of heart failure appear
ŞFKSevere restriction of physical activity. The patient feels comfortable only at rest, but less than usual. With minimal physical exertion, symptoms of the disease occur
IV FCInability to perform any load without discomfort. Symptoms of heart failure appear at rest, and any physical activity leads to an increase in the corresponding sensations

In recent years, the functional classification of chronic heart failure of the New York Heart Association has been increasingly used in Russia. The basis of this classification is the principle of assessing the physical (functional) capabilities of the patient, which can be identified by the doctor with a focused, thorough history, without the use of complex diagnostic techniques. Within this classification, four functional classes (FC) are distinguished (table 7).

Function class6 minute distance (m)
1FK426 – 550
II FC300 – 425
III FC150 – 300
IV FCless 150

The main method for determining exercise tolerance in chronic heart failure is to assess the distance of a 6-minute walk (6-minute test). The essence of this method is as follows. It is necessary to measure the distance in meters that the patient can go in 6 minutes at the maximum possible pace for him.

A 6-minute period of time was chosen due to the convenience of conversion for determining the speed in km / h (you need to multiply the distance traveled by the patient in meters by 10 and divide by 1000). The parameters of the 6-minute walk test for various functional classes of chronic heart failure are presented in table 8.

a) general weakness

c) pain in the right hypochondrium

a) general weakness

b) shortness of breath

c) attacks of cardiac asthma

g) hemoptysis after physical exertion

e) peripheral edema, enlarged liver, ascites

a) position of orthopnea

b) swelling of the internal jugular vein

c) protodiastolic gallop rhythm

d) alternating pulse

e) all of the above

a) pulmonary embolism

b) left ventricular myocardial infarction

c) chronic lung disease

d) pulmonary valve insufficiency

e) stenosis of the left atrioventricular foramen

c) severity in the right hypochondrium

8. Which of the following symptoms is not characteristic of chronic right ventricular heart failure?

a) severity in the right hypochondrium

b) loss of appetite and nausea

d) cough with sputum with streaks of blood after physical

b) severe hypertensive crisis

c) mitral stenosis

g) myocardial infarction

e) mitral valve insufficiency

a) acute right ventricular heart failure

b) acute left ventricular heart failure

c) chronic right ventricular heart failure

d) interstitial pulmonary edema

e) alveolar pulmonary edema

1 – d 3-d 5-d 7-6 9-a

2-d 4 -d 6-a 8 -g 10 -g

Lead system. Normal ECG Electric axis of the heart. Atrial hypertrophy. Ventricular hypertrophy

Manifestations

All cardiac diseases have a similar clinical picture. Left ventricular failure has symptoms in the form of painful sensations in the region of the heart that extend to the neck, shoulder blade, and left arm. Feverish conditions and a sharp increase in blood pressure are also observed.

The severity of manifestations depends on the size of the lesion. With this disease, a person suffers from:

  • shortness of breath, which develops into suffocation;
  • dry cough with frothy sputum arising from seizures;
  • discharge of foam from the oral cavity and nose;
  • the need to constantly be in a sitting position;
  • wet wheezing while breathing;
  • swelling of the cervical veins.

If congestive processes develop in the pulmonary circulation and an acute form of the disease occurs:

  • sharply begins shortness of breath, turning into an attack of asthma;
  • there is an accumulation of extravascular fluid in the tissues of the lungs and swelling of the organ;
  • cardiogenic shock occurs, in which muscles cannot contract normally and blood flow is disturbed throughout the body.

If the development of cardiogenic shock is associated with a violation of the heart rhythm, then it is called arrhythmic. In response to severe pain, a reflex shock occurs. With the defeat, more of the muscles of the left ventricle observe true shock. The latter option occurs in patients after 60 years of age, after heart attack attacks, which suffer from diabetes and hypertension.

Congestive processes in the pulmonary circle are usually triggered by myocardial infarction, in which there is a sharp decrease in blood volume and sodium is minimally retained.

Establishing diagnosis

Left ventricular failure has quite pronounced symptoms. The doctor can determine an acute attack using an external examination. Since this condition threatens a person’s life, every health worker with a secondary education should be able to determine it.

After collecting an anamnesis, the doctor listens to the chest. In this case, the presence of dry and wet rales is observed. Dry wheezing is often confused with bronchial asthma. It is possible to determine that this is pulmonary edema by the presence of cardiac pathologies, the absence of asthma attacks, dry and wheezing during exhalation.

The pulse is also counted, blood pressure indicators are measured, the level of oxygen in the blood is determined. Typically, saturation is reduced to 85%. This is an indication for hospitalization of the patient in cardioreanimation.

Therapy

Left ventricular failure has a complex treatment. Before starting therapy, oxygen therapy is mandatory. The patient is prescribed medication for:

  • normalization of the contractility of the heart muscle;
  • eliminate the manifestation of tachycardia;
  • prevention of blood clots and blockage of blood vessels;
  • restoration of the process of fluid elimination
  1. Diuretic drugs to remove excess fluid and improve kidney function.
  2. Beta-blockers that reduce the load on the heart.
  3. Inhibitors of angiotensin-converting enzyme to prevent further expansion of the cavities of the heart and normalization of pressure.
  4. Cardiac Glycosides. Under their influence, the amount of blood ejected in one reduction increases.
  5. Nitrates. They allow you to get rid of the symptoms of pathology, expanding blood vessels.

To eliminate the causes of the attack, carry out:

  • coronarography to restore patency of arteries in a person who has had a heart attack;
  • stenting necessary to expand the lumen of the vessels;
  • prosthetics if heart valves are affected;
  • radiofrequency ablation and laser cauterization in case of arrhythmia.

If these methods did not bring any results, then the only option is a heart transplant. In the case of severe myocardial damage, an artificial apparatus is installed to facilitate manifestations.

Therapy is carried out only in the intensive care unit.

Forecast

If a person suffers from a chronic form of the disease, then the prognosis depends on the stage of its development. In the initial stages, proper treatment can achieve good results.

The cause of death in left ventricular failure is most often cardiogenic shock. More than 80% of patients die from it. Usually, due to untimely help.

Prevention

In the chronic form of the disease, a person should constantly be under the supervision of a doctor. It is important to give up drinking alcohol and smoking, avoid stress and normalize your psycho-emotional state.

The patient needs moderate physical activity. It is important to regularly walk in the fresh air, run, engage in swimming.

The patient should constantly monitor blood pressure and observe nutritional rules. Fiber should be present in the diet, there should be no fried, fatty and spicy dishes. At the first signs of deterioration, you need to contact a medical institution.

With left ventricular failure, most patients die from complications. Therefore, it is important to begin treatment in the early stages of development until significant damage to the muscles of the heart has occurred.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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