Right Left Chronic Heart Failure Flashcards
Epidemiology
LHF - Most common reason for hospitalisation worldwide, M>W until older age. Very common
RHF - 1 in 20 people
Aetiology
LHF - Hypertension, MI diabetes, valve disease, congenital, drugs, CAD, constrictive pericarditis, aortic stenosis, anemia, stress, thyroid disease, dyslipidemia, family history.
RHF - Pulmonary hypertension caused by L heart failure, Right ventricle infarction or pulmonary disease (infarction, occlusion, hypertension, chronic bronchitis and emphysema)
Increased resistance to R heart output leads to congestion in the peripheral and portal venous systems.
Other causes include,
congenital heart disease, clots in pulmonary arteries, , and heart valve disease.
Pathogenesis
LHF Attempts to compensate for increased demand or decreased output lead to structural changes in the L ventricle and decreased output.
RHF - the right ventricle loses its pumping function, and blood may back up into other areas of the body, producing congestion. Congestion affects the liver, the gastrointestinal tract, and the limbs, peripheral and portal venous systems.
Natural History
LHF - Progressive burden on R heart and pulmonary circulation with potential for MI.
RHF - progressive organ failure -hronic bronchitis and emphysema.
Symptoms
LHF - orthopnea, paroxysmal nocturnal dyspnea, dyspnea usually exertional, weakness, intermittent claudication, nocturia, cerebral symptoms, cough, palpitations, syncope.
RHF - Fatigue, Anorexia, GI distress and bloating, Shortness of breath Swelling of feet and ankles Urinating more frequently at night Pronounced neck veins Palpitations (sensation of feeling the heart beat). Irregular fast heartbeat Fatigue Weakness Fainting
Physical Signs
LHF - displaced apex, gallop beat, cyanosis in advanced stages.
RHF - Oedema, ascites, hepatomegaly, signs of portal hypertension, visceral complaints.
Abnormal heart sounds, such as a murmur Abnormal lung sounds Ankle swelling Distended neck veins Enlarged liver Irregular or rapid heartbeat Weight gain
Complications
LHF Pulmonary oedema, R heart failure, pulmonary hypertension, increased sympathetic activity via renin-angiotensin system to increase venous return leading to oliguria.
RHF - Impaired liver and digestive function
Arrhythmias (abnormal heart rhythms), which may be life-threatening
Fainting
Repeat hospitalizations
Side effects of heart failure medications
Manifestations
LHF - displaced apex, gallop beat, cyanosis in advanced stages.
RHF - Oedema and visceral complaints. Shortness of breath Swelling of feet and ankles Urinating more frequently at night Pronounced neck veins Palpitations (sensation of feeling the heart beat) Irregular fast heartbeat Fatigue Weakness Fainting
Prognosis
LHF - Post-hospitalisation mortality 10% in 30 days to 43% in 5 years with increased risk with every re-hospitalisation.
RHF - no curable but treatable - mostly by treating LHF, lifestyle, diet modification etc.
and using implanted devices with defibrillation capabilities.
