Right ventricular heart failure. Right ventricular failure: stages and symptoms, treatment of acute and chronic forms, life prognosis

Right ventricular failure as an independent pathology has been identified relatively recently. Previously, heart failure meant disorders associated with dysfunction of the left ventricle. But recent studies by scientists have made it possible to see a significant difference between the work of the right and left sections of the main organ. Right ventricular heart failure occurs due to impaired blood flow in the small circle, as a result of dysfunction of the myocardium. Often the pathology is called "cor pulmonale".

Causes of the disease

Right ventricular failure can occur acutely or chronically, while occurring as an independent disease or be the result of another disorder occurring in the body. The causes of right ventricular failure are different. Pathology may occur as a result of:

• extensive;
• valvular tension pneumothorax;
• acute attack of respiratory failure;
• extensive acute pneumonia;
• with myocardial infarction;
• pathology such as myocarditis.

develop this disease may be against the background of pathologies of the respiratory organs (emphysema, bronchial asthma, bronchitis, as a result of sarcoidosis), scoliosis, poliomyelitis, autoimmune diseases. The disease can result from thromboembolism, vasculitis, tumors.

In the case of the development of right ventricular failure, the causes of the disease may be associated with congenital heart defects, severe obesity, in which the amplitude of diaphragm movement decreases. can cause right ventricular pathology.

Manifestations and symptoms of the disease

For right ventricular heart failure, certain symptoms are characteristic, which are more pronounced in the acute period of the disease. The main symptoms of the disease can occur in the form of:

• rapid heartbeat;
• arterial hypotension;
• shortness of breath and difficulty breathing;
• swelling of the respiratory organs;
• pulsation and swelling of the jugular veins;
• acrocyanosis.

With stagnation of blood, other signs are added, which manifest themselves in the form of an enlarged liver, discomfort in the right hypochondrium, swelling of the legs and anterior part of the peritoneum. Fluid may accumulate in the chest cavity and peritoneum, and blood circulation in the kidneys may be disturbed.

Right ventricular failure can be manifested by chronic hypertension, gastritis, mental disorders. Only a doctor can determine the exact cause after a thorough examination of the body.

Right ventricular failure can occur in a chronic form, and the main symptom of the pathology is often edema, which initially can be small and occur in the form of an increase in body weight and a decrease in urine output. Puffiness is more pronounced in the area of ​​​​the feet and legs, and with an increase in pathology, they spread to the area of ​​​​the thighs, lower back, and abdominal wall.

A person with this disease quickly gets tired, physical and mental performance decreases. The patient may be irritable, suffer from insomnia, be depressed (with low cardiac output, reduced blood supply to the brain and disruption of the central nervous system). congestive gastritis and functional disorders liver, which are a consequence of the disease, will give characteristic symptoms in the form of nausea, vomiting, bloating, constipation.

Signs of illness - jaundice skin, renal edema, swelling of the veins in the neck. A person can experience both a sharp weight gain and a strong loss of it, which is a consequence of progressive heart failure. The skin of the legs is affected by trophic ulcers.

Diagnosis and treatment of pathology

The heart is one of the main organs in human body, a motor without which a person cannot live. Diseases of cardio-vascular system often lead to death, so it is very important to identify the disease in a timely manner and start its therapy with drugs.

Comprehensive, aimed at eliminating main reason, symptomatic therapy is used to help eliminate painful symptoms.

It is rather difficult to identify right-sided heart failure, for the reason that it rarely manifests itself as an independent disease. It is very important for a person who periodically or constantly has symptoms associated with a violation of cardiac activity to consult a doctor and undergo a series of studies.

An electrocardiogram is the name of the procedure by which left or right ventricular failure can be determined. To clarify and confirm the diagnosis, ultrasound, MRI, x-rays are prescribed. In addition, the patient will need to donate blood for analysis for a comprehensive study.

If acute deficiency is observed, it is urgent to find out and eliminate its cause:

• dissolve or promptly remove the thrombus from pulmonary artery;
• reduce pulmonary hypertension using Eufillin and ganglionic blockers;
• treat a state of shock using sympathomimetics and intravenous solutions;
• restore blood flow through the arteries, if the cause of insufficiency is a heart attack;
• antibacterial agents are prescribed for pneumonia;
• taking glucocorticosteroids is indicated for an asthmatic attack.

If observed chronic insufficiency right ventricle, then therapy will be aimed at reducing blood stasis with the help of diuretics. Often indicated in congenital heart disease surgical intervention including organ transplant. Medications are prescribed to relieve the symptoms of the disease.

The prognosis of survival in patients with right ventricular heart failure depends on the cause that provoked the development of pathology. In the most severe cases (with PE), this period is from 3 to 5 years.

Disease prevention

Keeping the heart healthy is important for every person, because not only the quality of life, but also its duration depends on it. There is no separate prevention of right ventricular failure. All the rules are the same as for the prevention of cardiac diseases in general.

In particular, a person is advised to healthy lifestyle life. This includes quitting smoking, alcohol, fatty foods. Be sure to walk in the fresh air, perform simple physical exercises. Frequent stresses and depressions greatly worsen the work of the heart, therefore, such conditions should be avoided to the maximum, treating all life's troubles calmly.

With heart disease, any emotional outbursts are very harmful and dangerous. This applies not only to negative, but also to positive emotions that arise while watching your favorite football match, for example. Life should be smooth, measured, without bursts of emotional and physical. In addition to not being nervous, it is forbidden to walk quickly, run, and perform hard physical work. It is impossible to load the left side of the body, the left limb for a long time and strongly (to cut, chop, lift heavy objects).

It is necessary to eat properly and fractionally. It is important. You need to eat often, but the portions should be small. The diet can contain absolutely all products - these are vegetables, fruits, meat, fish, greens, all kinds of cereals, sour-milk food. The main thing is to cook them correctly, steamed, boiled or in the oven. Salt intake should be controlled, which should be very small in the diet. Salt retains fluid in the tissues, which can worsen the patient's condition and lead to the development of edema.

Heart disease is dangerous, but with the right routine - calm and measured, a person can lead a fairly high-quality lifestyle and live for a long time.

It is important to conduct an examination of the organ in the hospital every six months with the help of ultrasound and ECG. If the condition worsens, you should contact a specialist immediately.

Video

Heart failure is a disorder in the functioning of the muscles of the heart. The most common diagnosis is left ventricular failure. But if the violations relate to the pulmonary circulation, then in this case there is right ventricular failure. This syndrome is very dangerous. The patient needs urgent medical attention.

Causes of right ventricular failure

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 does not occur in this case;
• a decrease in blood flow to the left ventricle is characteristic, which leads to an increase in the load on the right;
• bronchospasm causes the blood flow to find new paths (from right to left) and put a strain on the right ventricle.

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 by which the syndrome occurs may differ depending on whether it is in the acute or chronic stage.

X ronic stage

• Various serious disorders of the respiratory system.
• Pathologies of the spine or muscular system that lead to limitation of movement chest.
• Violation of hemodynamics in a 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.

O straight stage

• Detachment of a massive thrombus in the pulmonary artery.
• Valvular pneumothorax.
• A strong, long-term non-stopping attack of bronchial asthma.
• Acute widespread pneumonia.
• Myocarditis.
• Myocardial tissue infarction in the right ventricle, or left with an effect on the right.
• Damage to the interventricular septum.

Symptoms

Manifestations of right ventricular heart failure begin with the fact that there are signs of stagnation of the pulmonary circulation and are unchanged.

• tachycardia;
• pressure drop;
• shortness of breath, feeling of lack of air;
• chest pain perceived as pressure;
• decrease in skin temperature;
• cyanosis of the extremities and nasolabial triangle;
• jugular veins become visible, their pulsation is observed;
• fainting is possible;
• pulmonary edema may occur.

The mechanism of development of insufficiency implies an increase in symptoms. The clinic of blood stagnation in a large circle is connected, which is usually accompanied by left ventricular failure:

• there are pains in the right hypochondrium due to enlargement of the liver;
• the legs swell, and in more severe cases, the abdominal wall;
• ascites and hydrothorax develop;
• impaired hemodynamics in the kidneys, which can cause serious complications;
• the amount of urine produced decreases.

A patient with these symptoms needs immediate health care.

Possible types

There are several classifications of heart failure. According to the nature of the course, acute and chronic syndromes are distinguished.

• Acute right ventricular failure has pronounced symptoms. The mechanism of its development is fast, and the clinical course is usually extremely severe. Treatment of this form is not always possible. Often ends in death. acute form may present as pulmonary edema. But left ventricular failure is much more common.
• Chronic right ventricular failure has a milder and more prolonged mechanism of development.

There are four types of severity:

1. I - absent external symptoms insufficiency;
2. II - there are small wheezing, a weak degree;
3. III - the number of wheezing increases, a more pronounced degree;
4. IV - very low pressure, cardiogenic shock.

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

• HI - hidden stage. Physical activity causes shortness of breath and palpitations. Decreased overall performance. Hemodynamic parameters at rest are not disturbed.
• HII - violation of hemodynamics is observed even at low loads, and sometimes at rest. It is divided into two periods:
• HIIA - with little physical exertion, shortness of breath appears. There are manifestations of stagnation in the pulmonary circulation: dry cough, the presence of wet rales and crepitus, hemoptysis occurs. There is a palpitation and interruptions in the work of the heart. In the evenings, violations of the systemic circulation begin to appear: slight swelling and enlargement of the liver. Employability drops sharply.
• HIIB - shortness of breath occurs already at rest. All symptoms are aggravated. Prolonged pains appear, pronounced 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, which is not treatable. The syndrome causes irreversible changes in the internal organs. Metabolism is disturbed, which leads to complete exhaustion patient.

Diagnostics

Video: Heart failure - medical animation.

Important diagnostic criteria to determine right ventricular failure are:

• changes during an objective examination;
• expanding the boundaries of the heart;
• systolic murmur that increases on inspiration;
• tachycardia;
• weak pulse;
• changes in the electrocardiogram;
• characterized by darkening on x-rays.

If the patient is prescribed serious treatment, then additional diagnostics may be needed:

• 6-minute walk trial;
• echo-KG;
• measurement of pressure in the pulmonary artery;
• doppler;
• CT and MRI;
• monitoring of the right ventricle.

It must also be carried out differential diagnosis with severe lung diseases, which may have a similar mechanism of development.

Treatment

Emergency medical care should be provided to patients if right or left ventricular failure is present. Therapeutic measures are aimed at eliminating the symptoms and treating the underlying disease. If the syndrome is in an acute stage, then the cause must be removed immediately. First aid should be provided as soon as possible:

• eliminate a thrombus from the pulmonary artery;
• reduce pulmonary pressure with ganglionic blockers and aminophylline;
• eliminate state of shock intravenous infusion of solutions;
• prescribe antibiotics for pneumonia;
• restore blood flow in a heart attack;
• stop an attack of bronchial asthma with corticosteroids;
• drain the pleural cavity with pneumothorax.

If the syndrome has acquired chronic course, then the treatment can be as follows:

• emergency therapy with diuretics - this will reduce congestion;
• antihypertensive therapy of the pulmonary artery:
• calcium channel antagonists;
• angiotensin-converting enzyme inhibitors;
• nitrates;
• blockers.
• cardiac glycosides - help with atrial fibrillation;
• surgical intervention to eliminate the defect, a heart transplant is possible. In this case, only a cardiac surgery clinic can come to the rescue.

Predictions for the course of the disease

Right ventricular failure syndrome often ends unfavorably. If emergency first aid was not provided in 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. They undergo irreversible changes.

If emergency medical care is started for a patient with pulmonary circulatory insufficiency syndrome, it is possible to significantly extend his life and improve its quality. And, although often the forecast this disease adverse, modern medicine gives you a chance to feel better.

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Causes of right ventricular failure

Acute right ventricular failure develops when:

massive thromboembolism of the pulmonary artery;

serious attacks of bronchial asthma;

rupture of the septum between the ventricles;

myocardial infarction;

acute pneumonia.

The chronic form of pathology is provoked by:

congenital heart defects;

constructive pericarditis;

pathology of the respiratory system;

pronounced obesity;

disorders of the pulmonary circulation system;

• aortic aneurysms.

Disease classification

Allocate acute and chronic forms of pathology.

An acute condition is dangerous because it develops in just a few hours or days. It is characterized by a serious condition of the patient. This condition leads to hemodynamic disturbances. To save life, urgent resuscitation measures are necessary.

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

Also distinguish:

"Pure" (primary) insufficiency. This pathology is very rare.

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

Both forms of the condition are amenable to therapy.

Symptoms of right ventricular failure

For acute insufficiency the following features are characteristic:

decrease in skin temperature;

pulsation and swelling of the jugular veins;

increased heart rate;

• pulmonary edema.

Chronic insufficiency is characterized by:

pain in the right hypochondrium;

circulatory disorders of the kidneys;

enlargement of the liver;

accumulation of fluid in the abdominal and chest cavities;

swelling of the lower extremities.

Often, patients get tired quickly, suffer from a reduction in mental and physical activity, and insomnia. Some patients are depressed. This is due to the fact that with low cardiac output, the blood circulation of the brain is reduced and the work of the central nervous system. Liver disorders and congestive gastritis that occur against the background of the condition also make themselves felt. Patients often suffer from constipation, nausea, bloating, and even vomiting.

Any symptom of right ventricular failure is easily confused with signs of many other diseases. That is why, in case of any suspicion of a pathology, you should immediately contact professionals.

The prognosis largely depends on the severity of the patient's condition, the duration of the course of the disease and its features. Massive thromboembolism, for example, often causes death. If the pathology is detected in time and its therapy is started, it is possible to save not only the life, but also the health of the patient.

Diagnostics

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

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

Chest X-ray. This survey provides an opportunity to determine inflammatory processes, pneumothorax and hydrothorax. In some cases, specialists also detect pulmonary edema. This pathology needs separate therapy.

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

All of these examinations are usually carried out when a patient is admitted to a hospital with acute insufficiency.

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

24 hour Holter monitoring.

Blood test for troponins, D-dimers and other indicators.

FVD (examination of the function of external respiration).

Research is informative bronchial asthma, chronic obstructive bronchitis and other major pathologies.

The complex of diagnostic measures is selected individually, depending on:

the patient's condition;

existing symptoms;

previous illnesses.

Additionally, vascular studies may be performed.

Treatment

Therapy is always selected individually and depends on the underlying pathology.

Patients with bronchopulmonary diseases undergo treatment adjustments. Thanks to this, it is possible to reduce the number of exacerbations and reduce the load on the heart. Improving the functionality of the lungs allows you to provide oxygen to all internal organs. Patients with heart defects often undergo surgery. They allow you to eliminate even severe pathologies.

When right ventricular failure is detected, patients are usually recommended to take certain drugs.

Among them:

Diuretics.

Calcium channel antagonists.

These drugs reduce blood flow to the right atrium. In addition, they dilate blood vessels, which can reduce pulmonary hypertension. Medicines eliminate not just the signs of pathology, but its causes.

Important! Certain medications are often taken for life. This is due to the fact that without special means, decompensation will quickly occur. The patient can be taken out of it only in a hospital.

Launched insufficiency requires:

compliance with bed rest;

absolute rest;

refusal of physical and emotional stress.

In some cases, small physical activity is allowed (provided that you feel normal).

Particular attention is paid to the diet.

Reduce fluid intake. Due to this, the increase in edema volumes is prevented.

Salt free diet. By adhering to it, you can avoid fluid retention in the body.

Eat only easily digestible meals with plenty of vitamins and minerals.

We take a holistic approach to therapy. Thanks to this, you can count on its maximum efficiency. At the same time, the prices of therapy are not overestimated by us. The exact cost of services depends on many factors. The doctor can calculate it after consultation and diagnosis with the formulation of all diagnoses. The approximate price for the services of our clinic in Moscow can be found even by phone.

Prevention

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

giving up bad habits;

proper nutrition;

maintaining emotional calm;

weight control;

active lifestyle.

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

To prevent deterioration of the condition allow:

regular consultations with a specialist;

taking prescribed medications;

moderate physical activity.

Clinic advantages

High level of qualification of specialists.

Optimal prices for examinations and therapy.

Compliance with medical ethics.

Wide diagnostic possibilities.

Comfortable atmosphere, open and sincere attitude of the staff.

Team interaction of specialists.

Availability of proven therapeutic programs.

Personally oriented approach to each patient.

Contact us! Each patient is valuable to us primarily as a person, and not as a patient with interesting history illness or a client that creates the material well-being of a specialist. In our clinic, you do not spend money on treatment, you invest it in your health.

Isolated acute right ventricular failure much less common than left ventricular acute cardiac failure. This is due to the fact that the right ventricle is more resistant to ischemic damage due to a more favorable ratio between its need for oxygen and delivery conditions to it. Therefore, most often right ventricular failure occurs some time after the development of severe left ventricular failure.

In acute right ventricular failure, there is a sudden increase in central venous pressure (swelling of the neck veins, increased pulsation of the internal jugular vein), tenderness and enlargement of the liver, severe dyspnea without orthopnea (patients usually prefer to lie down), tachypnea, hypotension or clinical picture shock.

What causes acute right ventricular failure?

Acute right ventricular failure is most often observed in the following conditions:

The clinical picture of right ventricular failure can develop with right ventricular infarction, rupture of the interventricular septum, pulmonary embolism, congenital and acquired heart defects.

The development of right ventricular failure with symptoms of congestion may be due to the pathology of the pulmonary artery and the right heart (exacerbation chronic disease lungs with pulmonary hypertension, massive pneumonia, pulmonary embolism, tricuspid valve dysfunction due to trauma or infection).

It is possible to develop it in acute or subacute pericardial disease, progression of severe insufficiency of the left parts of the heart with involvement of the right parts, as well as decompensation of a long-term congenital heart disease.

The main non-cardiac causes are nephritis, nephrotic syndrome, end-stage liver disease, and tumors that secrete vasoactive peptides.

As a rule, the development of right ventricular failure is due to an increase in pressure in the pulmonary artery and the involvement of the right ventricular myocardium in the zone of necrosis and peri-infarction myocardial damage.

Symptoms of acute right ventricular failure

The main symptoms of acute right ventricular failure are pronounced venous congestion with a large circle (if there is no hypovolemia) and the absence of congestion in the lungs.

Clinically, right ventricular failure is manifested by an increase in the liver, swelling of the cervical veins, the appearance of peripheral and abdominal edema. There is an increasing tachycardia, lowering blood pressure, cyanosis, shortness of breath. There is a sharp increase in central venous pressure.

On the electrocardiogram, acute right ventricular failure can be manifested by a rightogram, an acute development of blockade of the right leg of the Hiss bundle. "Gothic" R in II, III, aVF

Treatment of acute right ventricular failure

In all these cases, the use of diuretics and vasodilators is contraindicated. After the introduction of diuretics or vasodilators, there is always a decrease in blood pressure, up to severe hypotension or shock. With a decrease in blood pressure, intravenous fluid administration is indicated (plasma-substituting solutions at a rate that maintains blood pressure at a level of 90-100 mm Hg). With insufficient effect, dobutamine infusion is used. Milrinone may be used.

In cases of severe refractory hypotension - infusion of dopamine, norepinephrine, intra-aortic counterpulsation, circulatory support.

Treatment is with diuretics, including spironolactone, and sometimes a short course of low-dose (“diuretic”) dopamine.

With the development of right ventricular failure, venous vasodilators are contraindicated, since they, by reducing venous return, reduce cardiac output.

To correct arterial hypotension in right ventricular failure, the administration of plasma substitutes or plasma is indicated to increase the preload on the right ventricle in combination with dobutamine and arterial vasodilators (hydralazine or phentolamine).

Dobutamine in combination with phentolamine causes peripheral arterial vasodilation, reduces left ventricular afterload, left atrial pressure, and pulmonary artery pressure. This leads to a decrease in right ventricular afterload and an increase in its ejection.

Stroke output can also be increased by injecting fluid directly into the pulmonary artery.

Antibiotics are indicated for pulmonary infection and bacterial endocarditis.

Primary pulmonary hypertension is treated with calcium antagonists, nitric oxide, or prostaglandins.

Acute right ventricular failure is treated based on the treatment of the underlying disease: for pulmonary thromboembolism - the appointment of heparin and thrombolytic therapy, for tamponade - pericardiocentesis and drainage of the pericardial cavity, for myocardial infarction - thrombolytic therapy or surgical treatment.

general description

General description of the disease

Right ventricular heart failure is pathological condition, which is characterized by the inability of the right ventricle to provide its main function - pumping blood and its supply in the proper volume to the pulmonary artery. As a result, the right ventricle is no longer able to receive a normal amount of blood from the right atrium, into which the upper and lower vena cava. Blood stagnates in them, and then in the entire systemic circulation, resulting in characteristic clinical manifestations.

Depending on the origin and characteristics clinical course, right ventricular heart failure can be divided into the following forms:

1. Congestive insufficiency of right ventricular function - a complication of left ventricular failure, defects mitral valve and tricuspid valves, certain forms of pericarditis, myocarditis, congestive type cardiomyopathy, severe coronary artery disease.
2. The insufficiency of the ejection of blood is a consequence of the narrowing of the pulmonary artery.
3. Degenerative insufficiency of the right ventricular function is not a separate form of the disease, but its final stage, when very pronounced metabolic disorders are observed in the heart muscle.

Manifestations and symptoms

How to understand and recognize the disease

Manifestations and symptoms

Clinical manifestations of right ventricular heart failure are quite similar and specific, although in the initial stages with low degree expression and may not always be adequately recognized. However, each individual form of the disease has its own characteristics.

With congestive right ventricular heart failure, the veins in the neck swell, the fingers, the tip of the nose and earlobes become bluish in color (acrocyanosis), edema appears, which can be located in different parts of the body, but most often capture the feet and shins. A slight jaundice may also occur, since the liver often suffers from insufficiency of the right ventricle.

Insufficiency of ejection of blood from the right ventricle is a condition that long time may not appear at all and be fixed only during instrumental research. In the stage of expressed clinical manifestations the signs of this form of the disease are identical to those of the congestive form. The dystrophic form, or, more precisely, the stage of right ventricular heart failure, proceeds most severely and is manifested by the following symptoms:

1. General severe emaciation of the patient.
2. Skin disorders - thin, shiny skin that has become flabby and almost completely lost its pattern.
3. Very pronounced edema, which can be located not only on the legs, but also reach higher up to the face, can be localized in the abdomen and chest cavity.
4. A metabolic disorder in the body, which is detected during biochemical analyzes.

While left ventricular failure has been the subject of intense discussion for decades, right ventricular heart failure has generally remained with minimal attention. Indeed, the right half of the heart has long been considered a relatively passive channel for blood flow between the systemic and pulmonary circulations, and its disorders were considered relatively mild.

Right ventricular heart failure (RVHF) is a heart disease in which there is a malfunction of the right ventricle (RV). Today, left ventricular failure is more often diagnosed, although it is believed that isolated RVF has a more unfavorable prognosis.

Downstream, right ventricular heart failure is divided into acute and chronic, and in each case there are characteristic features in terms of the clinic, diagnosis and treatment.

PZHSN is also known as "cor pulmonale" because the right ventricle pumps blood through the pulmonary circulation through the lungs. The more the activity of the pancreas is impaired, the more pronounced the clinic of the disease and the higher the risk of pulmonary edema, which can subsequently result in the death of the patient. Therefore, it is extremely important to start treatment of the disease on time and carefully carry out the prevention of a recurrent attack of pancreatic insufficiency.

Video Right Sided Heart Failure - Explained in 2 Minutes (Right Ventricle Failure)

The reasons

There are two broad groups of factors contributing to the development of right ventricular heart failure.

• Primary right ventricular failure in the absence of pulmonary hypertension.
  • myocardial infarction
• Secondary failure of the pancreas against the background of an increase in the load or volume of pumped blood.
  • Pulmonary embolism
  • Mitral valve disease with pulmonary hypertension
  • congenital heart defects
  • Obstructive sleep apnea
  • Major lung resection
  • Left ventricular dysfunction
  • Atrial septal defect
  • Ventricular septal defect

More recently, high mortality among patients with isolated RV myocardial infarction has been identified, which forced us to reassess the importance of the risk of the disease.

Various congenital heart defects are often associated with RV failure, usually due to increased workload, volume overload, or both. Septal defects are usually associated with PZHSN; as a rule, due to the fact that the blood is discharged from the left side of the heart to the right. Tetralogy of Fallot is another congenital malformation in which RV hypertrophy and eventual RV failure are due to obstruction of the pulmonary artery that receives blood from the RV. In an adult with a repaired tetralogy of Fallot, RV failure may still occur due to pulmonary regurgitation, especially when the tricuspid valve has been used to repair the structure of the affected vessel.

Risk factors

Risk factors for right heart failure may include:

• Age: men between 50 and 70 often experience right-sided heart failure, especially if they have had a previous heart attack.
• Chronic diseases: lung pathologies such as COPD or pulmonary fibrosis, diabetes, HIV, hyperthyroidism, hypothyroidism, or iron/protein accumulation can lead to right-sided heart failure.
• Irregular heartbeats (arrhythmias): abnormal heart rhythms, especially if they are very frequent and fast, can weaken the heart muscle.
• Lung pathologies: blood clots or high blood pressure in the lungs may increase the risk of right-sided heart failure.
• Inflammation of the pericardium: the disease provokes a decrease in the size of the pericardial sac, which compresses and tightens the heart muscle.
• Racial Predisposition: African-American men are at higher risk than others for developing right-sided heart failure.
• Some chemotherapy and diabetic drugs: certain medicines have been found to increase the risk of PZHSN.
• Valvular heart disease: damage or defect in one of the four valves of the heart can prevent efficient hemodynamics.
• Viral infection: some viral diseases can damage the heart muscle, including the right ventricle.

Pathogenesis

The main stages of the formation of PZHSN:

• Dilatation of the RV chamber leads to enlargement of the tricuspid annulus, which causes regurgitation through the tricuspid valve, further exacerbating ventricular dilatation.
• Over time, hypertrophy of the pancreas occurs as a natural response to increased stress.
• As the RV increases, the crescentic shape of the ventricular cavity is disrupted.
• The interventricular septum protrudes into the LV cavity. This is because the pericardium limits the space available for expansion of the heart, and therefore an increase in RV size must be accompanied by a decrease in LV volume.
• Septal displacement impairs LV filling and therefore impairs LV function. This phenomenon is called ventricular dependence.
• As LV dysfunction develops, systemic blood pressure and coronary blood flow decrease, further impairing RV function.

With an unfavorable development of PZHSN, high venous pressure is determined in combination with a decrease in systemic arterial pressure, which worsens the perfusion of the main organs. Such disorders can lead to persistent circulatory failure, which ultimately causes failure of all organs and death.

Clinic

At the beginning of the development of right ventricular heart failure, the signs are mild. With the addition of LV dysfunction, the clinical picture becomes more pronounced.

Signs and symptoms of RV heart failure include the following:

• The appearance of shortness of breath, first with physical activity and then at rest
• Orthopnea (semi-sitting position)
• Chest pain
• Reduced arterial pressure
• Rapid heartbeat
• tachycardia
• Fatigue and weakness
• Lack of urination or little urine output
• Anorexia, weight loss, nausea
• Exophthalmos and/or visible eye pulsation
• Rattling in the chest, often distantly audible
• Central or peripheral cyanosis, pallor

In severe cases, there is ascites, an increase in the size of the liver, or even anasarca.

Video Heart failure - symptoms and treatment

Diagnostics

At the appointment with a cardiologist, a physical examination of the patient is mandatory, during which it can be determined:

• peripheral edema;
• pulsation of the jugular veins;
• hepatomegaly;
• systolic murmur of tricuspid regurgitation;
• accent of the second tone.

After analysis general condition the patient must be assigned instrumental methods research. Due to the unusual anatomy of the pancreas, assessing its function is a challenge. However, advances in technology, especially in echocardiography and cardiac MRI, are helping to determine right ventricular function and volumes, as well as measuring pulmonary artery pressure.

Instrumental research methods for PZHSN:

• echocardiography
• Electrocardiography
• Magnetic resonance imaging
• Chest x-ray
• Invasive diagnostic methods
• Maximum load testing
• Pulse oximetry (determination of the amount of oxygen in arterial blood)

Electrocardiography

ECG in most cases is assessed within the normal range. When determining right axis deviation, a pulmonary embolism is suspected.

Chest x-ray

This research method has limited opportunities and does not specifically identify right ventricular heart failure. However, dilatation of the base of the pulmonary artery and veins approaching the heart, as well as oligemia of the heart chambers (Westermarck's sign) - all this indicates pulmonary embolism and PZHSN.

Invasive Monitoring

Most often, pulmonary artery catheterization is performed, which allows measuring pressure in the pancreas, LA, determining LA occlusion and cardiac output. When each of these indicators is obtained, a distinction can be made between primary PZHSN and secondary, combined with an increased load on the heart. Especially importance has a transpulmonary gradient - the mean arterial pressure in the LA. The study also determines pulmonary vascular resistance, calculated by dividing the transpulmonary gradient by cardiac output. Important limitations that are considered when using a LA catheter are the unreliable measurement of cardiac output thermodilution with severe tricupid regurgitation and the risk of flotation balloon inflation in patients with severe pulmonary hypertension.

echocardiography

Today, transesophageal echocardiography (TE echocardiography) is preferred for assessing PZHSN. In experienced hands, this method allows immediate detection of an enlarged, hypertrophic, or poorly contracting RV and associated disorders such as tricuspid regurgitation and ventricular septal shift.

The following tests may be helpful in the initial assessment of suspected right ventricular heart failure:

• Complete blood count (PAC)
• Determination of the amount of iron
• Analysis of urine
• Electrolyte level
• Studies of kidney and liver function
• Fasting blood glucose level
• Lipid profile
• Thyroid-stimulating hormone (TSH) level
• B-type and pro-B-type natriuretic peptide level

Treatment

When determining right ventricular heart failure, various treatment strategies are used. First of all, the main ones are involved, and then the additional ones.

The main therapy for PZHSN includes:

• Prevention of the recurrence of an attack.
• Normalization of blood volume.
• Reducing the load on the heart.
• Prevention of hypercapnia and hypoxia.

Blood volume correction

Increased blood volume is normalized by reducing the amount of fluid and salt consumed. If this is not enough, diuretics and renal replacement therapy are used.

Artificial lung ventilation

It helps to reduce pressure in the capillary network in the lungs, which helps to improve the general condition of the patient.

Inotropes and vasopressors

• The most commonly used are beta-agonists, calcium sensitizers, and phosphodiesterase inhibitors. With their help, the load on the heart decreases, contractility and oxygen consumption by the myocardium increase.
• Levosimendan is indicated in cases where it is necessary to reduce pressure in the LA and improve RV function.
• Norepinephrine, phenylephrine and vasopressin improve ventricular contractility and thus have a positive effect on perfusion coronary arteries, but if not used properly, increase myocardial oxygen consumption.
• Milrinone and amrinone increase cardiac contractility through a non-beta-adrenergic mechanism.

Load reduction

• Sildenafil is an oral drug, a phosphodiesterase enzyme.
• Milrinone (PDE-III inhibitor): Reduces pulmonary pressure and can be administered via a nebulizer.
• Systemic vasodilators - hydralazine and others that help normalize coronary perfusion.
• Recombinant BNP (brain natriuretic peptide) - nonseritide, which reduces the preliminary and subsequent workload on the heart, thereby improving myocardial function without inotropic effect.

Surgical treatment to support the pancreas

If medications are not effective in treating right heart failure or the symptoms are very severe, a ventricular pacing device or heart transplant may be needed.

• Ventricular assist device implant surgery(VAD): a special device after implantation helps a weak heart muscle to contract more efficiently.
• Heart transplants: surgery is performed when all other treatments for PZHSN have failed. The damaged heart is surgically removed and replaced with a healthy organ from a deceased donor.

Forecast

In general, despite significant improvements in medical and device therapy, mortality among patients with heart failure after hospitalization is 10.4% in the first 30 days, 22% after 1 year and 42.3% after 5 years.

Heart failure associated with acute myocardial infarction has an inpatient mortality rate of 20-40%; the same figure reaches 80% in patients who suffer from hypotension (for example, with cardiogenic shock).

Heart failure associated with systolic dysfunction is characterized by a mortality rate of up to 50% after 5 years.

The following risk factors additionally influence the prognostic conclusion of hospitalized patients:

• age (elderly and older);
• the presence of concomitant pathology;
• length of sick day.

In the absence of timely and adequate treatment, the risk of death from pulmonary edema or cardiac arrest is very high.

Prevention

Not all risk factors can be corrected, which is why it is important to take steps that would help reduce the likelihood of developing PZHSN.

• If you have diabetes, you need to watch what you have to eat, how regularly you eat, and what your blood glucose level is.
• Moderate exercise helps improve blood circulation and reduces stress on the heart muscle.
• Nutrition should be balanced: It is important to limit the amount of sugar, animal fat, cholesterol and salt. Eat more fruits, vegetables, whole grains, and low-fat dairy products.
• If new symptoms are experienced or side effects medications you are taking, you need to see a doctor.
• It is important to maintain a healthy weight: Losing extra pounds and maintaining a healthy weight reduces the workload on the heart.
• When diagnosing sleep apnea, the CPAP/BIPAP device should be used every night.
• Reducing stress levels can help prevent fast or irregular heartbeats.
• It is worth remembering the prescribed medications, which should be taken in accordance with the instructions:

In addition, it is important to reduce alcohol consumption, in some cases it may be necessary to completely stop drinking. You should also quit smoking, as smoking has an extremely negative effect on the cardiovascular system.

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