Right Heart Failure

Question 1

Right heart

Answer 1

Easily accepts large increases in volume and pressure w/out “getting angry”

BUT doesn’t do well w/ increased afterload
especially sudden increase (i.e. PE)

Question 2

most common cause

Answer 2

increase in afterload due to Left Heart failure

Question 3

Isolated Right HF epidemiology

Answer 3

much less common than combined Right and Left HF

Question 4

Isolated Right HF causes

Answer 4

pulmonary vascular or parenchymal disease

Question 5

Cor pulmonale

Answer 5

isolated right heart failure caused by pulmonary vascular or parenchymal disease

(heart disease caused by lung disease)

Question 6

Acute cor pulmonale characteristics

Answer 6

dilatation of right heart chambers

–>RV becomes distended w/ large volume of blood it’s unable to pump out

Question 7

Chronic cor pulmonale characteristics

Answer 7

hypertrophy
(right heart learns to be more like left heart)…

if more than can compensate, RV begins to dilate…superimposed on hypertrophy

Question 8

acute-on-chronic cor pulmonale

Answer 8

Chronic hypertrophy can’t compensate for work-load anymore, so RV begins to dilate on top of hypertrophy

Question 9

common causes of chronic cor pulmonale

Answer 9

pulmonary emphysema
recurrent pulmonary thromboembolism
interstitial lung disease
acute respiratory distress syndrome

Question 10

pulmonary emphysema

Answer 10

permanent destruction of airspaces, w/ elimination of capillaries in the alveolar walls that have been destroyed

right heart still pumps same amount of blood through a decreased vascular bed…increased pulmonary vascular pressure, resistance, and afterload work for right heart

Question 11

recurrent pulmonary thromboembolism..

Answer 11

can lead to occlusion of pulmonary arteries by scar tissue of organized old thromboemboli…

Question 12

What do all the lung diseases that cause cor pulmonale have in common?

Answer 12

pulmonary HTN

Question 13

When can right heart failure cause left heart failure?

Answer 13

sometimes
when it fails to deliver enough venous return to left heart
much less common than vice versa

Question 14

first and most prominent symptom

Answer 14

lower leg edema, starting w/ feet

not specific though

Question 15

Other causes of pedal edema

Answer 15

nephrotic syndrome
obstruction of venous return through liver due to cirrhosis
DVT
protein-losing enteropathy
protein malnutrition

Question 16

Other symptoms

Answer 16

chronic low-grade RUQ discomfort (if blood back up is enough to cause liver congestion…stretches liver capsule)

ascites
anorexia
nausea (assoc. w/ edema of intestines)
weight gain from fluid retention

Question 17

signs

Answer 17

peripheral edema (esp legs)
hepatomegaly
asites
JVD

Question 18

Diagnosing

Answer 18

Echocardiography

Question 19

regulation of pulmonary circuit BP is…

Answer 19

mediated by different molecular mechanisms than systemic BP

so most HTN meds have limited effectiveness in lowering pulmonary BP

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