Heart failure left-sided

Left-Sided Heart Failure Right-Sided Heart Failure... 

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. 

A 57-year-old African-American man presents to the clinic for follow-up management of UC. He has had left-sided disease for 3 years and has been maintained in remission on maximal doses of oral mesalamine and prednisone 35 mg orally once daily. His provider has attempted several times to taper the prednisone dose, but the patient experiences a reappearance of symptoms if the dose is lowered below this level. Medical history is also significant for hypertension and heart failure. He has no known drug allergies. 

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. 

An 84-year-old patient with hypertensive cardiomyopathy developed bradycardia, fainting, and left-sided heart failure 3 weeks after starting treatment with donepezil. When donepezil was withdrawn, the sinus bradycardia disappeared 24-hour electrocardiography showed no signs of sinus node disease, and no episodes of this type recurred during the next 6 months. 

In a worldwide survey of AF ablation, major complications were reported in 6% of patients, including cardiac tamponade in 1.2%, stroke in 0.28% and transient ischemic attacks in 0.66% of left sided procedures (164). Periprocedural mortality was reported in 0.05%, Most thromboembolic strokes occur within two weeks of the ablation procedure (165). To reduce the risk of stroke, anticoagulation is often instituted prior to ablation, particularly in patients with CHADS-II risk factors (congestive heart failure or left ventricular dysfunction, hypertension,... 

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).

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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