Right ventricular heart failure – symptoms and treatment of acute and chronic forms

Acute right ventricular failure develops with:

massive pulmonary thromboembolism;

severe asthma attacks;

rupture of the septum between the ventricles;

The chronic form of pathology is provoked by:

congenital heart defects;

pathology of the respiratory system;

disorders of the circulatory system;

The mechanism of development of right ventricular failure is associated with such changes:

  • pulmonary hypertension, which gives a high load on the right ventricle. It is weaker, because left ventricular failure in this case does not occur;
  • a decrease in blood flow to the left ventricle is characteristic, which leads to an increase in the load on the right;
  • bronchospasm leads to the fact that the blood stream finds new paths (from right to left) and creates a load on the right ventricle.

Causes of chronic heart failure.

That is, the pathogenesis of the syndrome includes an increase in the load on the ventricle and a decrease in the lumen of the vessels. The factors that cause the syndrome may vary depending on whether it is in an acute or chronic stage.

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Chronic stage

  • A variety of serious respiratory disorders.
  • Pathologies of the spine or muscle system, which lead to restriction of chest movements.
  • Violation of hemodynamics in the small circle, which may be associated with internal or external compression.
  • The presence of congenital heart disease or constructive pericarditis.
  • Obesity, which limits the movement of the diaphragm.

Oh Straya Stage

  • Separation of a massive thrombus in the pulmonary artery.
  • Valve pneumothorax.
  • A strong, long unresponsive, attack of bronchial asthma.
  • Acute extensive pneumonia.
  • Myocarditis.
  • Myocardial infarction in the right ventricle, or left with an effect on the right.
  • Damage to the interventricular septum.

Possible types

There are several classifications of heart failure. By the nature of the course, acute and chronic syndrome are distinguished.

  • Acute right ventricular failure has pronounced signs. The mechanism of its development is fast, and the clinical course is usually extremely difficult. Treatment of this form is not always possible. Often fatal. The acute form may manifest as pulmonary edema. But left ventricular failure is much more common.
  • Chronic right ventricular failure has a milder and longer developmental mechanism.

By severity, four types are distinguished:

  1. I – there are no external symptoms of failure;
  2. II – small rales are observed, a weak degree;
  3. III – the number of wheezing is growing, a more pronounced degree;
  4. IV – very low pressure, cardiogenic shock.

There is another classification that divides the development mechanism of the syndrome into three stages:

  • HI is the hidden stage. Exercise causes shortness of breath and palpitations. The overall ability to work is reduced. Hemodynamic indicators at rest are not disturbed.
  • HII – hemodynamic impairment is already observed with minor loads, and sometimes at rest. It is divided into two periods:
  • HIIA – with small physical exertion, shortness of breath appears. There are manifestations of stagnation in the pulmonary circulation: dry cough, the presence of wet wheezing and crepitus, hemoptysis occurs. There is palpitations and interruptions in the work of the heart. In the evenings, disturbances in the large circle of blood circulation begin to appear: minor swelling and enlarged liver. Disability drops sharply.
  • HIIB – shortness of breath occurs already at rest. All symptoms increase dramatically. Long pains appear, marked cyanosis of the tissues, the heart muscle works intermittently. Edema is constant, the liver is enlarged. Such patients are completely disabled.
  • HIII is the final stage that cannot be treated. The syndrome causes irreversible changes in the internal organs. Metabolism is impaired, which leads to complete exhaustion of the patient.

Acute vascular insufficiency

In the pathogenesis of acute vascular insufficiency, the mismatch between the capacity of the vessels and the amount of blood circulating in them is crucial. Most often, loss of tone and vasodilation are observed in the abdominal organs. The stagnation of blood in them leads to the shutdown of a large amount of blood from the blood circulation.

Due to the decrease in the volume of circulating blood, insufficient blood supply to the brain and other organs is noted. On the other hand, a decrease in the volume of circulating blood is observed with blood loss, trauma, shock, dehydration. Acute vascular insufficiency can be clinically manifested in the form of fainting, collapse and shock.

Diagnostics

Diagnosis of the condition is carried out using such techniques as:

Electrocardiogram (ECG). During the examination, specialists quickly identify signs of overload of the right ventricle, complete or incomplete blockade of the right leg of the bundle of His, thromboembolism.

Chest x-ray. This examination provides an opportunity to determine the inflammatory processes, pneumothorax and hydrothorax. In some cases, specialists detect pulmonary edema. This pathology needs a separate therapy.

Ultrasound of the internal organs. This examination is performed if there is a suspicion of stagnation of blood in the liver, changes in the kidneys, etc. Ultrasound is especially important if the doctor thinks that the disease can only occur.

All these examinations are usually carried out upon admission to a hospital with acute failure.

After stabilization of the patient’s condition, the following examinations are prescribed:

Holter daily monitoring.

A blood test for troponins, D-dimers and other indicators.

FVD (study of the function of external respiration).

Studies are informative in bronchial asthma, chronic obstructive bronchitis and other underlying pathologies.

A set of diagnostic measures is selected individually, depending on:

previously transferred diseases.

Additionally, vascular studies can be performed.

Classification of the disease

Right ventricular failure syndrome often ends unfavorably. If emergency first aid is not provided on time, the patient may die. But a stopped attack still has a negative effect on the body and causes complications. This is due to insufficient blood supply to other organs and systems, which leads to the pathogenesis of the disease. Irreversible changes occur in them.

If emergency medical care is started for a patient who has circulatory failure, it can significantly extend his life and improve its quality. And, although the prognosis of this disease is often unfavorable, modern medicine gives a chance to feel better.

Acute and chronic forms of pathology are distinguished.

An acute condition is dangerous because it develops literally in a few hours or days. It is characterized by a serious condition of the patient. This condition leads to hemodynamic disorders. To save life, it is necessary to carry out emergency resuscitation measures.

The chronic condition develops for a long time, usually several years, against the background of chronic pathologies of the bronchi and lungs, the main heart diseases.

“Pure” (primary) failure. This pathology is very rare.

Secondary failure. Such a pathology is usually provoked by a wide range of diseases of a cardiac and non-cardiac nature.

Therapies respond to both forms of the condition.

Prevention

Prevention of insufficiency (like any other pathologies of the cardiovascular system) comes down to:

giving up bad habits;

maintaining emotional calm;

Of course, in some cases it is simply impossible to prevent the disease (especially if we are talking about a genetic predisposition to it). Nevertheless, risks can always be reduced. It is important to understand that usually right ventricular failure occurs against the background of the underlying disease. It is important to carry out its prevention. The doctor will tell you about this.

To prevent deterioration of the state allow:

regular consultations with a specialist;

taking prescribed medications;

moderate physical activity.

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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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