Heart failure. When talking about it, people usually mean changes that are associated with impaired functioning of the left ventricle. And only some time ago, scientists became interested in the work of the right ventricle. Studies have shown a significant difference in the functioning of the left and right parts of the heart. Right ventricular failure occurs due to a violation of the pulmonary circulation due to myocardial dysfunction. Therefore, it is sometimes called the pulmonary heart.
Causes of right ventricular failure
Heart failure can occur in a chronic or acute form, be secondary or primary. Based on the type of disease, experts identify several reasons for its occurrence.
Acute right ventricular failure (the symptoms we will discuss below) can develop with: rupture of the interventricular septum; massive pulmonary thromboembolism; myocarditis; a serious attack of bronchial asthma; right ventricular myocardial infarction; total acute pneumonia.
Etiology of right ventricular failure in a chronic form:
- With constructive pericarditis and congenital heart defects that occur, overloading the right ventricle (damage to the aortic valve; insufficiency of the triskupid valve).
- Pathologies of the respiratory system (bronchiectasis; sarcoidosis; emphysema; bronchitis; asthma).
- Severe obesity with reduced amplitude of diaphragm movement.
- Violation of the circulatory system (vasculitis; thromboembolism; pulmonary hypertension), compression from the outside (aortic aneurysm, tumor).
- Limited mobility of the chest, which is caused by diseases of the neuromuscular system (autoimmune diseases; polio), spine (ankylosing spondylitis, scoliosis).
Also, right ventricular failure can secondarily join left ventricular failure after a result of severe pulmonary circulation disorder was an increase in pressure in the vessels of the pulmonary artery and the occurrence of an overstrain of the right departments.
Symptomatology
Acute right ventricular failure causes pulmonary hypertension, resulting in a decrease in the amount of blood ejected by the left ventricle.
The following symptoms appear in the patient, rapidly increasing: the skin temperature decreases (acrocyanosis); heart palpitations; jugular veins pulsate and swell; there is a feeling of lack of air and shortness of breath; pulmonary edema due to increased capillary permeability. Chronic right ventricular failure manifests itself in a slightly different way.
Further, signs of stagnation of blood of a large circle of blood circulation are manifested:
- oliguria, impaired blood supply to the kidneys;
- soreness in the right hypochondrium due to capsule tension, enlarged liver;
- fluid accumulation in the chest and abdominal cavities (hydrothorax and ascites);
- swelling of the lower extremities and soon - the anterior abdominal wall.
It will be quite natural to develop mental disorders, which are caused by a disturbed outflow from the veins of the brain, hypertension and gastritis.
How is right ventricular failure detected?
Diagnosis
It is not possible to independently determine the right ventricular failure, this can be done by a specialist after a full diagnosis. In this case, clinical trials such as chest x- ray, MRI, ultrasound, ECG are indicated. Necessary laboratory tests - urinalysis, biochemical and general blood tests.
If a person has acute right ventricular failure, then when conducting an ECG, one can observe a strong overload of the right heart region, various neoplasms and changes in the myocardial region are determined by ultrasound. MRI is performed when the clinical picture is implicit.
What will the blood show?
On a general blood test, you can see the number of leukocytes, and therefore the degree of progression of the inflammation process. A biochemical blood test shows the presence of a potential threat to health and the state of the hormonal background. After the results of all studies and analyzes are in the hands of a specialist, after studying the patient’s complaints and conducting a re-examination, it will be possible to make an accurate diagnosis and prescribe an adequate treatment technique. If you have difficulty diagnosing, you will need to perform an MRI and X-ray.
Right ventricular failure is quite dangerous.
Disease prevention
Of course, there are cases when it is impossible to avoid heart disease, especially when it comes to genetic predisposition. But this does not mean that getting into a risk group frees a person from carrying out prophylaxis. Typically, cardiac right ventricular failure occurs against the background of any underlying disease, which makes the prevention a timely prevention of relapse of the pathological chronic process and maintaining the stage of remission for a long time.
Preventive measures require proper nutrition, an active lifestyle, emotional peace, a regular course of drug therapy, weight control and cardio loads. In the case of drug therapy, the use of unknown drugs is contraindicated without prior consultation with your doctor.
Right ventricular failure therapy
In the treatment of pulmonary heart disease, they are directed to eliminating the underlying disease and reducing the manifestation of heart muscle failure (symptomatic treatment). Acute right ventricular failure requires immediate elimination of the causes of its occurrence:
- Asthmatic status requires the appointment of glucocorticosteroids in a large dosage.
- Surgical removal or dissolution of a blood clot in the pulmonary artery is required for pulmonary embolism.
- Intense pneumothorax requires drainage of the pleural cavities located at the level of the second intercostal space.
- Pulmonary hypertension is reduced by ganglion blockers and aminophylline.
- Pneumonia requires the appointment of antibiotics with a wide spectrum of action.
- A heart attack requires restoration of blood flow in the coronary arteries.
- The shock condition is treated with intravenous solutions and sympathomimetics.
Chronic failure treatment
Chronic right ventricular heart failure is treated with slightly different methods. To reduce stagnation of blood of a large circle of blood circulation, diuretic therapy is often prescribed. Congenital heart disease often requires surgical intervention, including a heart / lung transplant or just a heart transplant. To reduce pressure inside the pulmonary artery, you can use:
- To reduce the total peripheral resistance of blood vessels, relax veins and arteries, alpha1-blockers are used.
- Calcium antagonists ("Diltiazem", "Nifedipine"), relaxing the smooth muscles of blood vessels in the pulmonary circulation, are more resistant to myocardial oxygen deficiency.
- A decrease in the amount of blood in the small circle and a decrease in venous return to the right atrium cause nitrates (isosorbide dinitrate).
- Resistance in the pulmonary artery, the volume of circulating blood, post- and preload on the right ventricle are caused by ACE inhibitors (Enalapril, Kapoten), which act on the renin-angiotensin-aldosthenic system.
What to do in case of complications?
With a complication of right ventricular failure in a chronic form of atrial fibrillation, the appointment of cardiac glycoside, digoxin is justified.
The likelihood of a positive effect of the therapy of the disease depends on the degree of damage to diseased organs and associated pathology. The most difficult therapy in patients with primary pulmonary hypertension and with repeated thromboembolism. When a patient has chronic decompensation of right ventricular failure, his life expectancy is no more than three to five years.
Isolated failure
More recently, researchers were interested in isolated right ventricular failure, which became possible after the advent of new techniques for studying the work of the heart. Scientists have found that its causes may be lung disease, as well as impaired functioning of the vessels of the pulmonary circulation and the right ventricle. We can conclude that in patients with lung diseases, in any case, heart failure forms, which can be considered as a complication. Primary right ventricular failure is extremely rare. Usually it is associated with congenital pathologies.
We examined such a thing as right ventricular failure. The treatment is described in detail.