Right heart failure

Introduction Right heart failure is mainly characterized by systemic congestion. Right heart failure is mainly right ventricular dysfunction, seen in pulmonary heart disease, tricuspid or pulmonary valve disease, and often secondary to left heart failure. At this time, the cardiac output is reduced, the systemic circulation is congested, and the venous pressure is increased, often accompanied by edema of the lower extremities, and systemic edema may occur in severe cases. Infection is a common cause of heart failure, so patients with chronic heart failure need early application of adequate antibiotics regardless of infection. Some frail patients have atypical symptoms when they are infected, and their body temperature is not necessarily high. They only show poor appetite and burnout. They should closely observe changes in the condition and prevent heart failure.

Cause

Right ventricular myocardial damage: large area right ventricular infarction.

Increased right ventricular afterload: massive pulmonary infarction (pulmonary infarction is caused by pulmonary embolism caused by extrapulmonary embolism, which causes lung tissue hemorrhage and necrosis, severe cases can be life-threatening. Click here to add pictures to explain pulmonary embolism (PE) Also known as pulmonary thromboembolism is the clinical and pathophysiological syndrome of pulmonary circulatory disorders caused by endogenous or exogenous emboli blocking the trunk or branches of the pulmonary artery.

Increased right ventricular preload: such as a large number of rapid venous blood transfusions, infusions.

an examination

Related inspection

Electrocardiogram Doppler echocardiography abdominal jugular vein reflow test M-mode echocardiography (ME) two-dimensional echocardiography

1. X-ray inspection:

According to the shape of the enlarged heart, it can be divided into aortic valve and mitral valve heart, which also contributes to the differentiation of pericardial effusion and cardiomyopathy. According to changes in pulmonary blood vessels and lung fields to determine whether there is pulmonary congestion and can be distinguished as active hyperemia or passive congestion. Active hyperemia is an important evidence of congenital heart disease from left to right, while passive congestion reflects only changes in heart failure.

2. ECG examination:

It can be found that myocardial infarction, myocardial ischemia, ectopic disease, conduction block, atrioventricular hypertrophy and strain provide an objective basis for the pathology or cause of heart failure.

3. Echocardiography and ultrasound Doppler:

For mitral stenosis and regurgitation, aortic stenosis includes two-leaf medicine. The Education Network has collected specific changes in aortic valve thick obstructive cardiomyopathy, pericardial effusion atrial tumor, atrioventricular or semilunar hernia, and congenital cardiovascular malformation. An important means for the diagnosis of heart disease ultrasound Doppler can selectively observe the disordered blood flow in a certain part of the heart cavity or large blood vessels, thereby diagnosing the nature and extent of the lesion and the location of congenital malformation.

Differential diagnosis

Differential diagnosis:

Left heart failure

1. Difficulty breathing: Dyspnea is the main symptom of early left heart failure.

(1) Labor difficulty breathing: dyspnea occurs only when heavy physical activity occurs, and can be relieved at rest. The main difference between normal and heart failure patients with labor dyspnea is that the latter also has an increased difficulty in breathing when normal people have activity. As the left ventricular dysfunction is aggravated, the labor intensity that causes difficulty in breathing gradually decreases.

(2) paroxysmal dyspnea at night: paroxysmal dyspnea often occurs at night. The patient suddenly woke up, felt a severe sense of suffocation and horror, and quickly sat up, and it took 30 minutes or more to ease. Usually accompanied by two lung wheezing, called cardiogenic asthma. The possible mechanism of the occurrence of interstitial fluid re-absorption and increased blood volume after bed rest, increased vagal nerve tension during sleep, related to small bronchospasm and supine position of diaphragmatic elevation, decreased lung capacity and other factors.

(3) sitting breathing: breathing difficulties occur quickly in the lying position, often appear in the lying position 1-2min, need to use a pillow to raise the head. In the supine position, the amount of blood returned to the heart, and left heart failure increased the left ventricular end-diastolic pressure, which further increased pulmonary vein and pulmonary capillary pressure, causing interstitial pulmonary edema, reducing lung compliance, increasing respiratory resistance and aggravating breathing difficulties.

(4) Acute pulmonary edema: further development of cardiogenic asthma.

2, cough, cough and hemoptysis: cough is an early symptom, often occurs at night, cough can be reduced or stopped when sitting or standing. Earthworms are usually serous, white foamy, sometimes with bloodshot sputum, such as high pulmonary capillary pressure, or pulmonary edema, plasma extravasation into the alveoli, may have a pink foamy sputum.

3, physical strength, fatigue and weakness: is almost all symptoms, the most common cause is respiratory difficulties after pulmonary congestion, and cardiac output can not be increased after exercise, cardiac output decreased due to tissue perfusion. Older people may have mental symptoms such as confusion, memory loss, anxiety, insomnia, hallucinations. Arterial pressure is generally normal, but pulse pressure is reduced.

4, urinary system symptoms: left heart failure redistribution of blood flow, early can increase nocturia. In severe left heart failure, cardiac output is severely decreased, renal blood flow is reduced and oliguria is present, or blood urea nitrogen, creatinine is elevated, and renal insufficiency is associated.

(1) General signs: Difficulty after exercise, severe cyanosis, jaundice, flushing of the ankle, decreased pulse pressure, decreased arterial systolic pressure, and fast pulse. Peripheral vasoconstriction is characterized by signs of sympathetic nervous system activity such as pale extremities, chills and fingertips, sinus tachycardia, and arrhythmia.

(2) Edema: occurs after jugular vein filling and hepatomegaly, which is a typical sign of right heart failure. First appeared in front of the foot, ankle, and tibia, and it was extended upwards and the whole body, and the development was slow. Edema occurred in the early days, and the degree of edema before going to bed was the heaviest, disappearing after sleeping.

Systemic, symmetric depression edema can occur in the advanced stage. When accompanied by malnutrition or liver function damage, when plasma albumin is too low, facial edema occurs, often indicating a poor prognosis.

5, pleural effusion and ascites: mainly related to increased body and pulmonary venous pressure and increased pleural capillary permeability. Generally, bilateral pleural effusion is more common, often with more pleural effusion on the right side. If it is a single side, it is more common on the right side. Ascites occurs mostly in the late stage of the disease and is mostly associated with cardiogenic cirrhosis.

6, other: hair tendon is mostly peripheral, or mixed, that is, central and peripheral hair coexist; severe and persistent right heart failure can have pericardial effusion, pulse pressure reduction or odd pulse. Whole heart failure can have both clinical manifestations of left and right heart failure, as well as clinical manifestations of left or right heart failure.

(1) Gastrointestinal symptoms: long-term gastrointestinal congestion, can cause loss of appetite, abdominal distension, nausea, vomiting, constipation and upper abdominal pain.

(2) Kidney symptoms: Kidney congestion causes renal dysfunction, less urine during the day, and nocturia. There may be a small amount of proteinuria, a few transparent or granular casts and red blood cells. Blood urea nitrogen can be elevated.

(3) Pain in the liver area: Hepatic congestion and hematoma, the liver capsule is dilated, the upper right abdomen is full of discomfort, and the liver area is painful. In severe cases, severe pain can occur and it is misdiagnosed as acute abdomen and other diseases. Cardiac cirrhosis can occur in chronic heart failure with long-term liver congestion.

(4) Dyspnea: In the case of simple right heart failure, there is usually no pulmonary congestion, and there is no obvious left heart failure in asthma. On the basis of left heart failure or right heart failure due to mitral stenosis, due to the reduction of pulmonary congestion, dyspnea is less severe than left heart failure.

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