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. Conducted studies have shown a significant difference in the functioning of the left and right parts of the heart. Right ventricular failure occurs due to impaired pulmonary circulation due to myocardial dysfunction. Therefore, it is sometimes called cor pulmonale.
Causes of right ventricular failure
Heart failure can be chronic or acute, secondary or primary. Based on the type of disease, experts identify several reasons for its occurrence.
Acute right ventricularinsufficiency (we will consider symptoms below) can develop with: rupture of the interventricular septum; massive thromboembolism of the pulmonary artery; myocarditis; a serious attack of bronchial asthma; myocardial infarction of the right ventricle; total acute pneumonia. Etiology of chronic right ventricular failure:
- For constructive pericarditis and congenital heart disease that overloads the right ventricle (damage to the aortic valve; tricuspid valve insufficiency).
- Pathologies of the respiratory system (bronchiectasis; sarcoidosis; emphysema; bronchitis; asthma).
- Severe obesity with reduced range of motion of the diaphragm.
- Violation of the pulmonary circulation system (vasculitis; thromboembolism; pulmonary hypertension), compression from the outside (aortic aneurysm, tumor).
- Restricted mobility of the chest, which is caused by diseases of the neuromuscular system (autoimmune diseases; poliomyelitis), spine (Bechterew's disease, scoliosis).
Also, right ventricular failure can secondarily join left ventricular failure after a severe pulmonary circulatory disorder has resulted in an increase in pressure in the vessels of the pulmonary artery and the occurrence of an overstrain of the right departments.
Symptomatics
Acute right ventricular failure causes pulmonary hypertension, resulting in a decrease in the amount of blood ejected by the left ventricle.
Uthe patient appears, rapidly growing, the following symptoms: the temperature of the skin decreases (acrocyanosis); heartbeat quickens; 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 somewhat differently.
Next, signs of blood stagnation of the systemic circulation appear:
- oliguria, impaired blood supply to the kidneys;
- pain in the right hypochondrium due to capsule tension, liver enlargement;
- accumulation of fluid in the chest and abdominal cavities (hydrothorax and ascites);
- swelling of the lower extremities and soon the anterior abdominal wall.
It is quite natural to develop mental disorders that cause impaired outflow from the veins of the brain, hypertension and gastritis.
How is right ventricular failure diagnosed?
Diagnosis
It is not possible to determine right ventricular failure on your own, this can be done by a specialist after a full diagnosis. In this case, clinical studies such as chest x-ray, MRI, ultrasound, ECG are indicated. Required laboratory tests - urinalysis, biochemical and general blood tests.
If a person has acute right ventricular failure, then during an ECG, one can observe a strong overload of the right heart section, various neoplasms andmyocardial changes. MRI is performed when the clinical picture is vague.
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 he alth 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 re-examining, it will be possible to make an accurate diagnosis and prescribe an adequate treatment method. If there is difficulty in making a diagnosis, an MRI and X-ray will be required.
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 falling into a risk group exempts a person from carrying out prophylaxis. Usually, right heart failure occurs against the background of some underlying disease, which makes the task of prevention timely prevention of relapses of the pathological chronic process and maintaining the remission stage for a long time.
Carrying out preventive measures requires proper nutrition, maintaining an active lifestyle, emotional calm, a regular course of drug therapy, weight control and cardio exercise. Contraindicated in drug therapytaking unknown drugs without first consulting your doctor.
Therapy for right ventricular failure
In the treatment of cor pulmonale, they are directed to eliminate the underlying disease and reduce the manifestation of heart muscle insufficiency (symptomatic treatment). Acute right ventricular failure requires immediate elimination of the cause of its occurrence:
- Asthmatic status requires high dose glucocorticosteroids.
- Surgical removal or dissolution of a thrombus in the pulmonary artery is required for PE.
- Tension pneumothorax requires drainage of pleural cavities located at the level of the second intercostal space.
- Pulmonary hypertension is reduced with ganglion blockers and aminophylline.
- Pneumonia requires broad-spectrum antibiotics.
- A heart attack requires restoration of blood flow in the coronary arteries.
- Shock is treated with intravenous fluids and sympathomimetics.
Chronic Deficiency Treatment
Chronic right ventricular heart failure is treated with slightly different methods. Diuretic therapy is often prescribed to reduce blood stasis in the systemic circulation. Congenital heart disease often requires surgery, including a heart/lung transplant or a heart transplant alone. To reduce the pressure inside the lungarteries, you can use:
- Alpha1-blockers are used to reduce total peripheral vascular resistance, relax veins and arteries.
- Calcium antagonists ("Diltiazem", "Nifedipine") make the myocardium more resistant to oxygen deficiency, relaxing the smooth muscles of the vessels in the pulmonary circulation.
- Reducing the amount of blood in the pulmonary circulation and a decrease in venous return to the right atrium cause nitrates (isosorbide dinitrate).
- Resistance in the pulmonary artery, circulating blood volume, post- and preload on the right ventricle are caused by ACE inhibitors (Enalapril, Capoten), which affect the renin-angiotensin-aldosthenic system.
What to do in case of complications?
When complication of right ventricular failure in a chronic form with atrial fibrillation, the appointment of a cardiac glycoside, digoxin, is quite justified.
The likelihood of a positive effect of therapy for the disease depends on the degree of damage to diseased organs and comorbidities. The most difficult therapy in patients with primary pulmonary hypertension and with repeated thromboembolism. When a patient has decompensated right ventricular failure in a chronic form, his life expectancy is no more than three to five years.
Isolated failure
Most recently, researchers have become interested in isolated right ventricular failure, which became possible afterthe emergence of new methods for studying the work of the heart. Scientists have found that lung diseases can be its causes, as well as impaired functioning of the vessels of the pulmonary circulation and the right ventricle. It can be concluded that in patients with lung diseases, in any case, heart failure develops, which can be considered as a complication. Primary right ventricular failure is extremely rare. It is usually associated with congenital abnormalities.
We have considered such a thing as right ventricular failure. The treatment is detailed.
