Cardiovascular: Right Ventricular Failure (brief)

Question 1

which side of the heart receives deoxygenated blood?

Answer 1

right atrium

Question 2

where does the right ventricle push blood to?

Answer 2

the lungs

Question 3

what can cause right ventricular failure?

Answer 3

• left ventricular failure
• pulmonary disease (cor pulmonale)
• septal defect

Question 4

what is Cor Pulmonale?

Answer 4

The pulmonary arteries constrict in response to low O2 levels, causing an increase in pulmonary blood pressure. This make is harder for the right side to pump the blood out so you get hypertrophy and subsequent heart failure.

Question 5

what is right ventricular failure?

Answer 5

• increased pressure in right ventricle = hypertrophy
• hypertrophy = less space in ventricle (less blood)
• heart cannot pump enough blood to meet demands of the body.

Question 6

when left and right ventricular failure occur together, what is this called?

Answer 6

congestive cardiac failure

Question 7

what signs on examination might there be in a patient with right ventricular failure?

Answer 7

cyanosis 
low BP 
narrow pulse 
pulsus alternans 
displaced apex 
RV heave 
signs of valve disease 
hypoxia 
raised JVP 
pitting oedema 
murmur

Question 8

what are the risk factors for right ventricular failure?

Answer 8

Left ventricular failure.
Pulmonary stenosis.
COPD.
Pulmonary embolism. 
Cystic fibrosis. 
Primary pulmonary hypertension. 
Smokers.
Increasing age.
More common in men or postmenopausal women.
Diabetes. 
Hypercholesterolemia.

Question 9

what are some clinical features of left ventricular failure?

Answer 9

Peripheral oedema (up to thighs, sacrum, abdominal wall).
Ascites.
Nausea.
Anorexia.
Facial engorgement.
Epistaxis.
Shortness of breath/increased breathlessness on exertion (cor pulmonale).

Question 10

what is pulsus alternans?

Answer 10

Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats. It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis.

Question 11

which conditions present in a similar way to right ventricular failure?

Answer 11

Pericardial diseases.
Liver diseases.
Nephrotic syndrome.
Protein losing encephalopathy.

Question 12

what investigations would you do to confirm a diagnosis of ventricular failure?

Answer 12

bloods (FBC; U&E; BNP)
CXR
ECG
Echo

Question 13

what is the management plan for ventricular failure?

Answer 13

Treat the cause (eg if dysrhythmias; valve disease).

Treat exacerbating factors (anaemia, thyroid disease, infection, ↑BP).

Avoid exacerbating factors, eg NSAIDs (fluid retention) and verapamil (−ve inotrope).