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Chronic Right-Sided Congestive Heart Failure

Chronic Right Sided Congestive Heart Failure


Presentation

  • Cardiac murmurs will be present if valvular heart disease is present, contributing to the HF such as aortic stenosis or mitral regurgitation.[healio.com]
  • The presentation of a patient dyspnea carries an extensive differential diagnosis from heart failure, MI, pulmonary embolism to pneumonia, sepsis, bronchitis, asthma, chronic obstructive pulmonary disease.[epmonthly.com]
  • Mediastinal lymph node enlargement may be present in some cases 13,14 .[radiopaedia.org]
  • Much less commonly, animals present because of signs referable to a decrease in cardiac output (forward heart failure). Very rarely, they present in cardiogenic shock (low blood pressure due to decreased cardiac output).[merckvetmanual.com]
Pleural Effusion
  • Pleural effusion Pleural effusion more evident on lateral view Pleural effusion is bilateral in 70% of cases of CHF. When unilateral, it is slightly more often on the right side than on the left side.[radiologyassistant.nl]
  • effusion (Medical Encyclopedia) Pulmonary edema (Medical Encyclopedia) [ Read More ][icdlist.com]
  • effusions Sputum analysis : : heart failure cells ( hemosiderin -containing cells) Thoracentesis Indicated if the etiology of the pleural effusion is unclear Pleural fluid analysis: Transudate effusions are typical of cardiogenic causes.[amboss.com]
  • Chest X-ray • Size and shape of heart • Evidence of pulmonary venous congestion (dilated or upper lobe veins perivascular edema) • Pleural effusion 29.[slideshare.net]
  • effusions Ultrasound: echocardiography Echocardiography is the most common imaging modality used to evaluate patients with CCF 1,2 .[radiopaedia.org]
Weight Gain
  • Fluid retention often results in weight gain. A common symptom is fatigue, which may be related to reduced blood flow to organs and muscles. Sometimes CHF reduces blood flow to the brain and causes confusion, especially in the elderly.[sharecare.com]
  • Call your doctor or other health care provider when you notice: Weight gain of 2-3 pounds in one day Shortness of breath Increase in fatigue Swelling in your ankles or belly Faintness or dizziness Changes in pulse and blood pressure Pounding heart beat[columbiasurgery.org]
  • Passing out during exercise Poor appetite Weight loss or lack of weight gain can be seen even in older children.[cincinnatichildrens.org]
  • Weight gain of 3 to 4 pounds in 1 or 2 days. Increased shortness of breath. Increased swelling of the ankles. Cough with sputum that is discolored or tinged with blood. Last updated 3 April 2018[nmihi.com]
  • gain over a short period of time, even when the appetite is poor, typically due to fluid retention Cough and congestion in the lungs Sweating while feeding, playing, or exercising Breathing difficulty with activity, especially while feeding, walking,[stanfordchildrens.org]
Pallor
  • Increased adrenergic activity is manifested by tachycardia, diaphoresis, pallor, peripheral cyanosis with pallor and coldness of the extremities, and obvious distention of the peripheral veins secondary to venoconstriction.[emedicine.medscape.com]
  • Pallor and diaphoresis in this medical emergency are common. The pulse may be thready and a blood pressure difficult to obtain. Respirations are labored, and rales are widely dispersed over both lung fields anteriorly and posteriorly.[ceufast.com]
Patient Appears Chronically Ill
  • Physical examination The patient appeared chronically ill, with facial swelling, mild scleral jaundice, lip cyanosis, engorgement of the jugular vein, and a reflux-positive liver jugular vein.[omicsonline.org]
Loss of Appetite
  • Edema occurs in many other areas, such as the abdominal cavity, the chest cavity, the pericardium, and in the stomach and intestines, which causes nausea and loss of appetite. Fluid retention often results in weight gain.[sharecare.com]
  • The condition may also result in weight gain; chest pain; loss of appetite or a feeling of indigestion; clammy skin; a fast or irregular heartbeat; feelings of restlessness or confusion; difficulty remembering things; insomnia (trouble sleeping); a need[dartmouth-hitchcock.org]
  • Loss of appetite (anorexia); nausea and/or vomiting. General feeling of poor health. Anxiety; in severe cases irritability, restlessness, and mental confusion may occur.[healthcentral.com]
  • Loss of appetite results from venous engorgement and venous stasis within the abdominal organs. Prevention Prevention of heart failure mainly lies in lifestyle management. Healthy diet.[nurseslabs.com]
Abdominal Distension
  • Abdominal distension was noted; the abdominal veins; the liver was palpable 2 cm below the ribs; and the “shifting dullness” test was positive.[omicsonline.org]
Heart Disease
  • Heart failure often is the end stage of another form of heart disease.[drugs.com]
  • disease with heart failure Hypertensive heart disease, w CHF Hypertensive heart failure Hypertensive heart/kidney dis w/ congestive heart fail Hypertensive kidney and heart disease Hypertensive kidney and heart disease, on dialysis Malignant hypertensive[icd9data.com]
  • disease with heart failure Hypertensive heart failure Hypertensive heart/kidney dis w/ congestive heart fail Hypertensive kidney and heart disease Hypertensive kidney and heart disease, on dialysis Ischemic cardiomyopathy with congestive heart failure[icd10data.com]
  • , it attempts to compensate by making structural changes Ischemic heart disease The most commonly reported cause of CHF is ischemic heart disease.[ceufast.com]
  • Congenital heart disease in which there is left-to-right shunt. Example: ( i) Patent foramen ovale ; (ii) Patent ductus arterisus and (iii) Interventricular septal defect. 5. Other causes: i) Extracardiac circulatory failure.[histopathology-india.net]
Tachycardia
  • Electrocardiogram • Old MI or recent MI • Arrhythmia • Some forms of Cardiomyopathy are tachycardia related • LBBB may help in management 28.[slideshare.net]
  • These include atrial fibrillation and ventricular tachycardia.[healio.com]
  • […] symptoms during less than ordinary physical activity, marked limitation (patients generally only comfortable at rest) NYHA IV: symptoms even when at rest, severe limitation Patients with end-stage CCF may have Cheyne-Stokes respiration, hypotension, tachycardia[radiopaedia.org]
  • Other compensatory changes are increase of blood volume by retention of salt and water and tachycardia. These compensatory changes finally, become burden on cardiac function, leading to progressive CHF. Left-sided cardiac failure: Causes: 1.[histopathology-india.net]
  • Fatigue, dypnea (related to inadequate Cardiac Output) Right Ventricular failure in the operating room could be associated with the following signs/symptoms: Hypotension Increased PCWP (in setting of PA catheter), although it may decrease as it worsens3 Tachycardia[openanesthesia.org]
Cyanosis
  • Physical examination The patient appeared chronically ill, with facial swelling, mild scleral jaundice, lip cyanosis, engorgement of the jugular vein, and a reflux-positive liver jugular vein.[omicsonline.org]
  • Extremities : Check for peripheral cyanosis – its caused when a lot of the hemoglobin in the blood isn’t carrying oxygen. Clubbing of the fingers is caused by chronic hypoxemia.[medictests.com]
  • History : Symptoms include shortness of breath with exercise, chronic cough that produces sputum, blue tinge around the mouth and fingernails (cyanosis), wheezing, weakness, tiring easily, and swelling of the lower extremities (edema).[nmihi.com]
  • […] nocturnal dyspnoea: dyspnoea that awakens the patient from sleep, usually only after 1-2 hours, and may have a chronic nocturnal cough and cardiac asthma 1,2 bendopnoea: dyspnoea while bending forward 3 angina 1,2 syncope and cerebral dysfunction 1,2 cyanosis[radiopaedia.org]
  • This is strongly suggestive of peripheral cyanosis.[ceufast.com]
Cardiomegaly
  • On the left a patient with cardiomegaly and redistribution. The upper lobe vessels have a diameter 3 mm (normal 1-2 mm). Notice the increased artery-to-bronchus ratio at hilar level (arrows). LEFT: normal.[radiologyassistant.nl]
  • Chest x-ray did not show additional changes besides those previously known such as cardiomegaly. Electrocardiogram showed atrial fibrillation with a normal heart rate. Brain natriuretic peptide was 690 ng/L.[austinpublishinggroup.com]
  • With left-sided congestive cardiac failure, the features are that of pulmonary oedema which includes 1,2,4-8 : central pulmonary venous congestion cephalisation of pulmonary veins pulmonary interstitial oedema pulmonary alveolar oedema cardiomegaly (may[radiopaedia.org]
  • […] liquid accumulates in alveoli due to left heart pressure overload alveoli pop open during inhalation, causing rales on exam abdominal exam ascites hepatojugular reflex Imaging Chest radiograph findings pulmonary vascular congestion pleural effusion cardiomegaly[medbullets.com]
  • Framingham Criteria for Dx of Heart Failure • Major Criteria: – PND – JVD – Rales – Cardiomegaly – Acute Pulmonary Edema – S3 Gallop – Positive hepatic Jugular reflex – venous pressure 16 cm H2O 22.[slideshare.net]
Hepatojugular Reflux
  • The fluid status is checked by jugular venous pressure, which usually gets accentuated by the hepatojugular reflux. If there is an increase in the right ventricular pressure, there will be presence of parasternal heave.[newhealthadvisor.com]
  • Marked hepatojugular reflux due to hepatic congestion. Hepatomegaly liver pulsatility if there is significant associated tricuspid regurgitation. Jaundice in advanced cases. Ascites in advanced cases. Peripheral pitting oedema.[patient.info]
  • Assess the liver for hepatojugular reflux. Measure the urinary output carefully to establish a baseline against which to assess the effectiveness of diuretic therapy. Weigh the patient daily in the hospital or at home.[nurseslabs.com]
  • Physical examination in states of right heart failure may reveal elevated jugular venous pressure including hepatojugular reflux, lower extremity pitting edema and ascites.[healio.com]
  • The hepatojugular reflux occurs in patients with elevated left-sided filling pressures and reflects elevated capillary wedge pressure and left-sided heart failure.[emedicine.medscape.com]
Hepatomegaly
  • Venous congestion in the systemic circulation results in jugular venous distention, hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal tract, and peripheral edema.[quizlet.com]
  • Abdominal examination elicited pain during superficial palpation on the right upper quadrant with hepatomegaly identification, with no signs of ascites.[austinpublishinggroup.com]
  • Hepatomegaly - Centrilobular congestion and atrophy of central hepatocytes (nutmeg liver).[histopathology-india.net]
  • Symptoms1 Failure of the Right Ventricle results in systemic venous hypertension, and can lead to the following signs/symptoms: Peripheral edema Anorexia, nausea, and abdominal pain related to congestion hepatomegaly Fatigue, dypnea (related to inadequate[openanesthesia.org]
  • […] ventricle during atrial systole hitting the stiff hypertrophied ventricular wall 1,2 pulsus alternans 1,2 right-predominant symptoms and signs nocturia 1,2 sacral and scrotal oedema, especially if bed bound 1,2 peripheral (ankle) oedema 1,2 ascites 1,2 hepatomegaly[radiopaedia.org]
Pulsatile Liver
  • Signs of RV failure include nontender peripheral pitting edema (digital pressure leaves visible and palpable imprints, sometimes quite deep) in the feet and ankles; an enlarged and sometimes pulsatile liver palpable below the right costal margin; abdominal[merckmanuals.com]
Increased Muscle Mass
  • Increasing muscle mass. As thickness of muscle increases, the heart pumps with greater force to maintain cardiac output. Increase heart rate. This increase will increase the cardiac output. Increase blood pressure.[bme240.eng.uci.edu]
Ulcer
  • We here report a case of Ebstein’s anomaly with refractory right-side heart failure and leg ulcers.[omicsonline.org]
  • There may be an eczema-type rash on legs, which can be complicated by ulcers that do not heal ( venous leg ulcers ). Possible accumulation of fluid in the abdominal cavity and organs, especially the liver.[netdoctor.co.uk]
Eczema
  • There may be an eczema-type rash on legs, which can be complicated by ulcers that do not heal ( venous leg ulcers ). Possible accumulation of fluid in the abdominal cavity and organs, especially the liver.[netdoctor.co.uk]
Skin Ulcer
  • Lower-extremity skin ulcers and infections Management The symptoms were treated by prescribing furosemide, spironolactone, trimetazidine dihydrochloride, coenzyme Q10, Essentiale, and Rivanol.[omicsonline.org]
Nocturia
  • O2 exchange), Crackles, pulmonary edema Left sided heart failure Symptoms Weakness, fatigue, anxiety, depression, dyspnea, shallow respirations up to 32-40 min, Paroxysymal Nocturnal Dyspnea, Orthopnea (SOB in recumbent position, dry hacking cough, nocturia[quizlet.com]
  • It can also cause nocturia, when the body fluid returns to the blood stream after lying down. Ascites will be caused in severe cases, which will further lead to liver enlargement and impaired liver functioning.[newhealthadvisor.com]
  • […] around in a large dilated ventricle) 1,2 S4 ‘atrial gallop’ (occurs before S1 and is due to blood entering the ventricle during atrial systole hitting the stiff hypertrophied ventricular wall 1,2 pulsus alternans 1,2 right-predominant symptoms and signs nocturia[radiopaedia.org]
  • D: Nocturia is not present in heart failure. 4. Answer: A. Stage I A: Stage I refer to a patient who reports no symptoms of heart failure at rest but becomes symptomatic with increased physical activity.[nurseslabs.com]
  • Biventricular (global) HF presents with clinical features of both left-sided and right-sided failure, as well as general symptoms such as tachycardia , fatigue, and nocturia .[amboss.com]
Oliguria
  • These mechanisms are responsible for the symptoms of diaphoresis, cool skin, tachycardia, cardiac arrhythmias, and oliguria.[medical-dictionary.thefreedictionary.com]
  • Oliguria is a late finding in heart failure, and it is found in patients with markedly reduced cardiac output from severely reduced LV function.[emedicine.medscape.com]
  • […] by the ACC/AHA guidelines for patients with heart failure that is refractory to diuretic therapy. [ 3 , 56] The 2017 ACC/AHA focused update noted the following five criteria may be indications for renal replacement therapy in these patients [ 56 ] : Oliguria[emedicine.medscape.com]

Workup

  • The diagnosis of CHF is based on clinical presentation and requires an initial workup to assess disease severity and possible causes. The initial workup includes measurement of brain natriuretic peptide levels, chest x-ray , and ECG .[amboss.com]
  • This is just one example of why it is so important that a complete diagnostic workup is made routinely.[ceufast.com]
Pericardial Effusion
  • On the left another patient with a large cardiac silhouette on the chest x-ray due to pericardial effusion. Pericardial effusion is demonstrated on the coronal CT-reconstruction.[radiologyassistant.nl]
  • effusion ( Figure 4 ).[omicsonline.org]
  • Imaging Echocardiography can help evaluate chamber dimensions, valve function, LVEF, wall motion abnormalities, LV hypertrophy, diastolic function, pulmonary artery pressure, LV and RV filling pressures, RV function, and pericardial effusion.[merckmanuals.com]
Cardiac Output Decreased
  • CHF occurs when the flow of blood from the heart ( cardiac output ) decreases, or fluid backs-up behind the failing ventricle, or both.[health.howstuffworks.com]
  • Blood flow through the Left Heart chambers and vessels In left ventricular failure, cardiac output decreases and pulmonary venous pressures increase.[ceufast.com]
Hyponatremia
  • Specifically, tolvaptan is approved by the FDA for the treatment of euvolemic hyponatremia and hypervolemic hyponatremia.[healio.com]
  • Monitor for hyponatremia. For pulmonary edema, an extreme of CHF, morphine and IV nitrates are adjuncts. Within the first twelve hours of presentation in the ED, ACE-inhibitors can be initiated as second-line therapy.[epmonthly.com]
  • Benefits I II III IV First-line drugs Diuretics ( loop diuretics and thiazide diuretics ) ( ) ( ) Begin treatment with loop diuretics ( furosemide ) to treat volume overload Thiazides may be added for a synergistic effect Monitor for hypokalemia and hyponatremia[amboss.com]
  • Conivaptan is the first drug approved by US Food and Drug Administration for the treatment of euvolemic hyponatremia in those with heart failure. [39] In rare cases hypertonic 3% saline together with diuretics may be used to correct hyponatremia. [39][en.wikipedia.org]
  • Prolonged diuretic therapy might lead to hyponatremia and result in disorientation, fatigue , apprehension, weakness, and muscle cramps. Dehydration and hypotension .[nurseslabs.com]
P Pulmonale
  • Electrocardiography in patients with pulmonary hypertension shows signs of RV hypertrophy in the form of right axis deviation, dominant R in V1 and dominant S in V5 or 6 P pulmonale.[escardio.org]
Pleural Effusion
  • Pleural effusion Pleural effusion more evident on lateral view Pleural effusion is bilateral in 70% of cases of CHF. When unilateral, it is slightly more often on the right side than on the left side.[radiologyassistant.nl]
  • effusion (Medical Encyclopedia) Pulmonary edema (Medical Encyclopedia) [ Read More ][icdlist.com]
  • effusions Sputum analysis : : heart failure cells ( hemosiderin -containing cells) Thoracentesis Indicated if the etiology of the pleural effusion is unclear Pleural fluid analysis: Transudate effusions are typical of cardiogenic causes.[amboss.com]
  • Chest X-ray • Size and shape of heart • Evidence of pulmonary venous congestion (dilated or upper lobe veins perivascular edema) • Pleural effusion 29.[slideshare.net]
  • effusions Ultrasound: echocardiography Echocardiography is the most common imaging modality used to evaluate patients with CCF 1,2 .[radiopaedia.org]

Treatment

  • Stage D treatment The usual treatment plan for patients with Stage D heart failure includes: Treatments listed in Stages A, B and C Evaluation for more advanced treatment options, including: Heart transplant Ventricular assist devices Heart surgery Continuous[my.clevelandclinic.org]
  • The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.[heartfailurecenter.com]
  • Treatment and Recovery Treatment for left-sided heart failure focuses on managing symptoms and treating underlying causes of the condition.[baptisthealth.com]
  • Treatment The treatment of heart failure focuses on: Lessening symptoms Decreasing hospitalizations Improving life expectancy To accomplish these goals, your doctor will advise a low-salt diet and medication.[drugs.com]

Prognosis

  • References: [33] [34] [35] Prognosis Prognosis estimates vary depending on patient characeristics, type and severity of heart disease, medication regimens, and lifestyle changes.[amboss.com]
  • 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 (arrhythmias).[medicinenet.com]
  • Treatment and prognosis Treatment involves a multidisciplinary team and incorporates lifestyle, allied health, pharmacological, and even surgical therapies, often specific to the underlying aetiology 1,2 .[radiopaedia.org]
  • Prognosis The prognosis for left-sided heart failure varies, depending on the cause of the condition and severity of the symptoms. Some will improve with treatment and lifestyle changes. For others, left-sided heart failure can be life-threatening.[baptisthealth.com]

Etiology

  • Etiology The three major causes of heart failure are coronary artery disease , hypertension , and diabetes mellitus . Patients typically have multiple risk factors that contribute to the development of HF![amboss.com]
  • Pathophysiology Etiology Symptoms Diagnosis Treatment Special Situations Introduction Congestive heart failure occurs when the cardiac output is not adequate enough to meet the demands of the body.[healio.com]
  • Other studies should be individualized depending upon the suspected etiology of RHF.[revespcardiol.org]
  • Etiology N Engl J Med. 2003 May 15;348(20):2007-18. Am J Cardiol. 2005 May 2;95(9A):8B-13B.[pathophys.org]
  • . , doxorubicin) smoking Etiology systolic dysfunction ischemic heart disease (most common) chronic hypertension dilated cardiomyopathy valvular disease congenital heart disease diastolic dysfunction hypertension with left ventricular hypertrophy hypertrophic[medbullets.com]

Epidemiology

  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • References: [2] [3] Epidemiological data refers to the US, unless otherwise specified. Etiology The three major causes of heart failure are coronary artery disease , hypertension , and diabetes mellitus .[amboss.com]
  • […] metabolic demand decompensated heart failure occurs when symptoms are worsened or exacerbated precipitating factors include infections arrhythmias excessive salt in the diet (post-holiday heart) uncontrolled hypertension thyrotoxicosis myocardial infarction Epidemiology[medbullets.com]
  • Epidemiology There are few reliable figures for prevalence of cor pulmonale in the population at large, as the condition is difficult to diagnose reliably on the basis of clinical symptoms and signs alone.[patient.info]
  • "The epidemiology of heart failure: the Framingham Study." Journal of the American College of Cardiology 22.4 Suppl A (1993): 6A-13A. CONTINUE SCROLLING FOR RELATED SLIDESHOW[medicinenet.com]
Sex distribution
Age distribution

Pathophysiology

  • Right Sided heart failure Pathophysiology Right sided heart failure occurs when the right ventricle fails to contract effectively. right sided heart failure causes a backup of blood into the right atrium and venous circulation.[quizlet.com]
  • Can J Anaesth: 2012, 59(6);586-603 [PubMed:22528163] [WorldCat.org] [DOI] (I p) François Haddad, Ramona Doyle, Daniel J Murphy, Sharon A Hunt Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management[openanesthesia.org]
  • Pathophysiology To make intelligent management decisions, you must first understand several key pathologic pathways in RV failure: RV response to increased PVR (i.e.[nuemblog.com]
  • Sun XG, Hansen JE, Oudiz RJ, Wasserman K: Exercise pathophysiology in patients with primary pulmonary hypertension . Circulation 2001, 104: 429–435. CrossRef PubMed Google Scholar 20.[link.springer.com]
  • Lilly, Pathophysiology of Heart Disease, 2007 Predominantly systolic dysfunction is seen in a majority of patients, while others exhibit mainly diastolic dysfunction . Components of both can also be found.[pathophys.org]

Prevention

  • Prevention While you cannot prevent all risks factors associated with left-sided heart failure, you can take steps to lower, or in some cases even reverse, your risks of diseases or conditions that can cause or complicate left-sided heart failure.[baptisthealth.com]
  • Prevention The key to preventing heart failure is to reduce your risk factors.[mayoclinic.org]
  • Prevention Prevention of heart failure mainly lies in lifestyle management. Healthy diet. Avoiding intake of fatty and salty foods greatly improves the cardiovascular health of an individual.[nurseslabs.com]
  • Others cannot be prevented but can be treated successfully.[emedicinehealth.com]

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