Heart Failure

Question 1

What is left sided heart failure?

Answer 1

• Most common type
  
  • Results from left ventricular dysfunction
  • Prevents normal forward movement of blood and causes blood to back up in the left atrium and pulmonary veins
  • Increased pulmonary pressure forces fluid leakage from the pulmonary capillary bed into the interstitium and then into the alveoli
  • Results in pulmonary congestion and oedema

Question 2

What is right sided heart failure?

Answer 2

• Results when the right ventricle fails to contract effectively
  
  • Causes a back up of blood in the right atrium and venous circulation
    Results in jugular venous distention, hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal tract and peripheral oedema.

Question 3

Clinical presentation of left and right sided heart failure?

Answer 3

Right sided
Fluid retention causing swelling in the lower limbs and sometimes the abdomen

left sided

• Awakening at night with shortness of breath.
• Shortness of breath during exercise or when lying flat.
• Chronic coughing or wheezing.

Question 4

What is acute decompensated heart failure/pulmonary oedema relation?

Answer 4

• An increase in the pulmonary venous pressure is caused by left ventricular dysfunction
  
  • Pulmonary vascular system becomes engorged
  • Lungs become less compliant and there is increased resistance in small airways
  • Interstitial oedema and tachypnoea develops – patient is now symptomatic
  • Alveoli and airways are flooded with fluid and RBCs = pulmonary oedema
  • Patient will be anxious, pale, possibly cyanotic (late sign). Resp rate over 30, use of accessory muscles, wheezing and coughing, with frothy, bloody tinged sputum.
  • Crackles, wheezes and rhonchi throughout the lungs
    Heart rate will be rapid and blood pressure may be elevated or decreased depending on the severity of the heart failure