Right heart insufficiency

Introduction Cardiac insufficiency refers to a pathological condition in which the blood discharged from the heart is insufficient to maintain tissue metabolism in the case of normal venous return. Clinically, it is characterized by insufficient cardiac output, reduced tissue blood flow, and pulmonary circulation and/or systemic congestion. Therefore, it is also called congestive heart failure.

Cause

The cause of right heart dysfunction:

1 Primary myocardial contractility is weakened, such as various myocarditis, cardiomyopathy and ischemic heart disease.

2 The heart is overloaded, including the preload (capacity load) and the after load (resistance load) are too heavy. Long-term overload can cause secondary myocardial contractility.

Chronic cardiac insufficiency in China includes: primary and secondary, including: unexplained and valvular disease, followed by hypertension and coronary atherosclerotic heart disease (chronic heart failure). The main causes are: infection, arrhythmia, water and electrolyte disorders, excessive fatigue, excessive mental stress, rapid changes in environmental climate, and pregnancy, childbirth and other diseases.

Clinically, chronic cardiac insufficiency is most common with left ventricular dysfunction, which primarily affects the patient's pulmonary circulation. Can be expressed as difficulty breathing, cough, cough, hemoptysis, nocturia, fatigue and weakness.

The elderly have many aging and diseases of other organs, so they can interfere with the clinical manifestations of some cardiac insufficiency. Many elderly people, even if they have heart dysfunction, do not feel acutely anxious during activities, but are characterized by extreme fatigue and coughing, often with unusual sweating. Left ventricular dysfunction is not easy to distinguish from chronic obstructive pulmonary disease and pulmonary infection.

Cardiac dysfunction has multiple classification criteria, according to its development process can be divided into acute cardiac insufficiency and chronic cardiac insufficiency; according to the site of the attack can be divided into left ventricular dysfunction, right heart dysfunction and total cardiac insufficiency; The basic principles that occur can be divided into systolic insufficiency cardiac dysfunction and diastolic dysfunction.

an examination

Related inspection

Thoracic and ascites routine examination of electrocardiographic serous effusion pathogen

Diagnosis of right heart dysfunction:

1. Symptoms: The pathological basis of right heart failure is caused by systemic congestion. Common appetite loss, nausea and vomiting, oliguria, edema and so on.

2. Signs: 1 jugular vein engorgement, liver neck reflow sign (+).

2 Liver enlargement or tenderness.

3 Edema: It is a drooping depression. In the sagging part of the body, the person who gets up is obviously visible on the inside of the foot, the inside of the ankle and the front of the ankle. The supine is the edema of the ankle. Severe body edema, with pleural effusion, ascites.

4 The right ventricle is enlarged or the whole heart is enlarged.

Differential diagnosis

Left heart dysfunction

symptom:

1 Dyspnea: the most important manifestation of left ventricular dysfunction, which occurs only after exertion in the early stage and is called labor dyspnea. As the disease progresses, rest will also occur. Severe cases are forced to take a sitting or semi-recumbent posture to ease, called sit-up breathing. Due to the sitting position, the blood is mostly deposited in the lower limbs, resulting in a decrease in the amount of blood returning to the vein. At the same time, the sitting position moves the diaphragm down and the lung capacity increases, which is beneficial to improve breathing. Typical manifestations of left ventricular dysfunction are paroxysmal nocturnal dyspnea, often after asleep at night, suddenly awakening, forced to sit up, may be accompanied by cough, foamy sputum, or asthmatic state, may be called cardiogenic asthma. The lighter person will relieve after a few minutes of sitting, and the severe one may develop pulmonary edema.

2 cough, sputum and hemoptysis: dry cough or a small amount of sputum, often white foamy serous, sometimes with blood, pink foam sputum, caused by alveolar and bronchial mucosal congestion.

3 purpura, fatigue, fatigue: the result of reduced blood output. In severe cases, due to cerebral ischemia and hypoxia, psychotic symptoms such as drowsiness, irritability, and even confusion may occur.

Signs:

The heart's voiced sounds expand, and the apex beats to the left and down with a sense of lift. The heart rate increases, the apex can be heard and the diastolic period runs, and the severe ones can appear alternately. The bottom of both lungs can smell wet sounds. It can also be accompanied by wheezing and dry snoring due to secondary bronchospasm. In severe cases, there is central purpura.

Right heart dysfunction

symptom:

Mainly due to functional changes caused by organ congestion, such as decreased urine output, increased nocturia, due to kidney congestion, sodium and water retention. Liver congestion can cause pain in the liver area or even jaundice; gastrointestinal congestion can cause loss of appetite, indigestion, nausea, vomiting and diarrhea.

Signs:

1 The heart sounds are widened, the apex beats are lifted, the range of beats is diffused, and the heart rate increases.

2 jugular vein engorgement, that is, in the semi-recumbent position or sitting position, the external jugular vein can be seen above the clavicle, which is one of the early manifestations of right heart failure.

3 hepatomegaly tenderness, positive for jugular jugular venous return (ie, the jugular vein is more filled when the swollen liver is compressed) is also an early manifestation of right heart failure, often before edema. Long-term right heart failure can lead to cardiogenic cirrhosis, when the liver is swollen, the texture becomes hard, often accompanied by jaundice, ascites and liver damage.

4 Depression edema, a typical sign of right heart failure, occurs in the sagging part of the body.

Heart failure

The clinical manifestations of left and right heart dysfunction are present at the same time, but one of them can be dominant. When the right heart is insufficiency, the right ventricle discharge is reduced, resulting in left heart dysfunction, the original cardiovascular disease or patients with heart failure, the symptoms and signs of pulmonary circulatory congestion, not difficult to diagnose as left heart failure; The symptoms and signs of congestion are not difficult to diagnose as right heart failure. X-ray examination, cycle time and venous pressure measurement, etc., often provide a basis for diagnosis.

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