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Chronic Right-Sided Congestive Heart Failure

Chronic Right Sided Congestive Heart Failure


Presentation

  • 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]
  • Snapshot A 60-year-old man presents to his primary care physician for several months of dyspnea on exertion, exercise intolerance, and lower-extremity swelling. He has a past medical history of sarcoidosis.[medbullets.com]
  • Mediastinal lymph node enlargement may be present in some cases 13,14.[radiopaedia.org]
  • However, during the initial presentation profound hypotension and shock may be present.[escardio.org]
  • Clinical presentation: 1. Due to obstruction to pulmonary vascular out-flow there is pulmonary congestion and edema. 2.[histopathology-india.net]
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]
  • Swelling in your ankles, legs and abdomen; weight gain. When your kidneys do not filter enough blood, your body holds onto extra fluid and water. Extra fluid in your body causes swelling edema and weight gain. Need to urinate while resting at night.[my.clevelandclinic.org]
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]
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 due to another disorder Pleural effusion due to congestive heart failure Red half-moon nail in congestive heart failure Refractory heart failure Symptomatic congestive heart failure Index to Diseases and Injuries References found for the code[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]
  • effusion cardiomegaly Kerley-B lines interstitial edema Echocardiogram indication confirms the diagnosis of heart failure classifies whether heart failure is due to systolic or diastolic dysfunction findings assess for low ejection fraction systolic[medbullets.com]
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]
  • A full ( bloated ) or hard stomach, loss of appetite or upset stomach ( nausea ).[my.clevelandclinic.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]
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 congestive heart failure Hypertensive heart failure Left heart failure Low cardiac output syndrome Low output heart failure Malignant hypertensive heart disease Malignant hypertensive heart disease with congestive heart failure Nail changes[icdlist.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]
  • ., 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]
  • Visit for more related articles at Journal of Vascular Medicine & Surgery Abstract Ebstein’s malformation is a congenital heart disease.[omicsonline.org]
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]
  • […] 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]
  • With left-sided congestive cardiac failure, the features are that of pulmonary edema which includes 1,2,4-8 : central pulmonary venous congestion cephalisation of pulmonary veins pulmonary interstitial edema pulmonary alveolar edema cardiomegaly (may[radiopaedia.org]
  • 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]
Tachycardia
  • Electrocardiogram • Old MI or recent MI • Arrhythmia • Some forms of Cardiomyopathy are tachycardia related • LBBB may help in management 28.[slideshare.net]
  • 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]
  • […] 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]
  • 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]
  • B-type (brain) natriuretic peptide ( ANP and BNP ) released by the ventricles and the atria in response to increased stretch elevated levels are often seen in decompensated CHF normal BNP excludes a diagnosis of CHF Electrocardiogram (ECG) findings sinus tachycardia[medbullets.com]
Cyanosis
  • 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]
  • 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]
  • 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]
  • […] paroxysmal nocturnal dyspnea: dyspnea 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: dyspnea while bending forward 3 angina 1,2 syncope and cerebral dysfunction 1,2 cyanosis[radiopaedia.org]
  • […] features Rapid exacerbation of symptoms of HF (see symptoms of left heart failure and symptoms of right heart failure ) Pulmonary edema with: Acute, severe dyspnea and orthopnea, worse when supine Cough (occasionally with frothing, blood-tinged sputum ) Cyanosis[amboss.com]
Distended Neck Veins
  • Distended neck veins. Bluish skin. Chest pain. Enlarged liver and swollen abdomen.[nmihi.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 edema, especially if bed bound 1,2 peripheral (ankle) edema 1,2 ascites 1,2 hepatomegaly[radiopaedia.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]
  • 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]
  • Nocturia At night when supine, blood flow is redistributed to the kidney, promoting perfusion and diuresis.[pathophys.org]

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]
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]
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]
Hyponatremia
  • 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]
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 due to another disorder Pleural effusion due to congestive heart failure Red half-moon nail in congestive heart failure Refractory heart failure Symptomatic congestive heart failure Index to Diseases and Injuries References found for the code[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]
  • effusion cardiomegaly Kerley-B lines interstitial edema Echocardiogram indication confirms the diagnosis of heart failure classifies whether heart failure is due to systolic or diastolic dysfunction findings assess for low ejection fraction systolic[medbullets.com]

Treatment

  • The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.[heartfailurecenter.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]
  • Treatment includes treating the underlying cause of your heart failure, medicines, and heart transplantation if other treatments fail. NIH: National Heart, Lung, and Blood Institute[medlineplus.gov]
  • Treatments for heart failure Treatment for heart failure usually aims to control the symptoms for as long as possible and slow down the progression of the condition.[nhs.uk]
  • It is mainly indicated in degenerative valve disease, but functional regurgitation treatment is currently being evaluated in randomized trials.[austinpublishinggroup.com]

Prognosis

  • References: [35] [36] [37] Prognosis[amboss.com]
  • Treatment and prognosis Treatment involves a multidisciplinary team and incorporates lifestyle, allied health, pharmacological, and even surgical therapies, often specific to the underlying etiology 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]
  • Chronic cor pulmonale is manageable, but the prognosis is that of the underlying lung disease. Survival is significantly longer when caused by uncomplicated emphysema.[nmihi.com]
  • Their rise reflects the severity of the condition and portends poor prognosis.[escardio.org]

Etiology

  • Clinical presentation varies considerably depending on the severity and etiology of CCF 1,2.[radiopaedia.org]
  • Etiology ADHF typically occurs in patients who have a history of chronic HF or other cardiac conditions in which an acute cause precipitates the deterioration of cardiac function.[amboss.com]
  • ., 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]
  • Etiology N Engl J Med. 2003 May 15;348(20):2007-18. Am J Cardiol. 2005 May 2;95(9A):8B-13B.[pathophys.org]
  • Etiology • It is a common end point for many diseases of cardiovascular system • It can be caused by : -Inappropriate work load (volume or pressure overload) -Restricted filling -Myocyte loss 4.[slideshare.net]

Epidemiology

  • […] 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]
  • 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]
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]
  • 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]
  • Pathophysiology • Hemodynamic changes • Neurohormonal changes • Cellular changes 8. Hemodynamic changes • From hemodynamic stand point HF can be secondary to systolic dysfunction or diastolic dysfunction 9.[slideshare.net]

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]
  • This prevents proper oxygen exchange. Failure to rapidly diagnose and treat congestive heart failure can result in death.[vshcarolinas.com]
  • This prevents normal, forward blood flow and causes blood to back up into the left atrium and pulmonary veins.[quizlet.com]
  • ACE inhibitors ACE inhibitors prevent the formation of a hormone that makes the blood vessels contract. This means that less effort is needed by the heart to pump blood.[netdoctor.co.uk]

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