Right side heart failure

Question 1

RHF may occur secondary to what conditions?

Answer 1

· Chronic lung disease.
· Pulmonary hypertension.
· Right heart valve disease. 
· Left to right shunts. 
· Isolated right ventricular cardiomyopathy.

Question 2

RHF is commonly associated with what condition?

Answer 2

Left side heart failure.

Question 3

What term is used to describe both left and right sided heart failure?

Answer 3

Congestive cardiac failure

Question 4

Elevated right atrial pressure leads to what?

Answer 4

Peripheral fluid retention.

Question 5

What are the typical presenting symptoms?

Answer 5

· Fatigue.
· Nausea.
· Wasting.
· Swollen ankles.
· Abdominal discomfort.
· Anorexia.
· Breathlessness.

Question 6

What are the typical presenting signs?

Answer 6

· Raised JVP. 
· Smooth hepatomegaly.
· Liver tenderness.
· Pitting oedema.
· Ascites.
· Tachycardia. 
· Right ventricular third heart sound.

Question 7

What investigations would you do to confirm RHF?

Answer 7

· FBC.
· U&Es.
· LFTs.
· Cardiac enzymes/troponin.
· TFTs. 
· ECG. 
· CXR.
· Echo.

Question 8

What investigation is the gold standard for RHF?

Answer 8

Echo

Question 9

What is the first line treatment for all heart failure?

Answer 9

Treat cause of heart failure.

Question 10

What are the management options for chronic heart failure?

Answer 10

Improve symptoms:
· Loop diuretics (e.g. furosemide).
· Digoxin.

Improve prognosis:
· ACE inhibitors/ARB. 
· Beta blockers.
· Spironolactone. 
· Warfarin.

Question 11

What are the management options for acute heart failure?

Answer 11

Resuscitation:
· Sit the patient upright.
· High flow oxygen unless existing hypercapnia.
· Respiratory support using NIV.

Therapies:
· Diamorphine.
· Diuretics.
· IV nitrates.