Heart failure left-/right- sided

Symptoms of left-sided heart failure include dyspnea, orthopnea, and paroxysmal nocturnal dyspnea (PND), whereas symptoms of right-sided heart failure include fluid retention, gastrointestinal bloating, and fatigue. 

Surgery is an important adjunct to management of endocarditis in certain patients. In most cases, valvectomy and valve replacement are performed to remove infected tissues and restore hemodynamic function. The most important indications for surgical intervention in the past have been heart failure in left-sided IE and persistent infections in right-sided IE. 

FIGURE 24-2 Effects of congestive heart failure. (A) Left-sided heart failure results primarily in pulmonary edema. (BJ Right-sided heart failure results in peripheral edema [swollen ankles, enlarged organs], (Adapted from Kent TH, Hart MN. Introduction to Human Disease. 2nd ed. Norwalk, CT Appleton-Century-Crofts 1987 141, with permission.]... 

What signs and symptoms experienced by this patient indicate that he has heart failure Does he have right- or left-sided heart failure or both Explain your answer. 

Figure 110.4 Relationships between T3 and left ventricular ejection fraction in patients with left ventricular dysfunction. Scatterplots showing the relationship between total T3 (TT3) and left ventricular ejection fraction (LVEF) in patients without (panel a) and with overt heart failure (panel b). Data from Pingitore etal., (2006) (left side) and from Pingitore etal., (2005) (right side).

Table 12-2 Defining Characteristics of Left-Sided and Right-Sided Heart Failure...

Right-sided heart failure results in edema of the body and body organs, whereas left-sided heart failure results in edema of the lungs. 

After venous access, some consideration should be given to the sequence of lead placement. Some operators prefer to place the RV electrode first for emergency RV pacing, should heart block ensue because the heart failure patients commonly have a left bundle branch block and any trauma to the conduction system or right bundle may result in complete heart block. Other operators choose to place the coronary sinus lead first and, if necessary, depend on heart rate support via a temporary transvenous pacemaker placed via the femoral vein. The issue of failure speaks for placing the coronary sinus lead first. Should the procedure fail with unsuccessful left-sided left ventricular lead placement and the patient has already received right-sided electrodes, a pacing system may be left without an indication unless a future second attempt is considered. As more and more systems are placed for a primary prevention indication like MADIT II, this has become less problematic (153). 

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