Heart failure right-sided

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

Cor pulmonale is right-sided heart failure, often secondary to chronic obstructive pulmonary disease (COPD). Because mannitol pulls fluid off the brain, it may lead to a circulatory overload, which the heart with right-sided failure could not handle. This client would need an order for a loop diuretic to prevent serious cardiac comphcations. 

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. 

Pulmonary hypertension develops late in the course of COPD, usually after the development of severe hypoxemia. It is the most common cardiovascular complication of COPD and can result in cor pulmonale, or right-sided heart failure. Hypoxemia plays the primary role in the development of pulmonary hypertension by causing vasoconstriction of the pulmonary arteries and by promoting vessel wall remodeling. Destruction of the pulmonary capillary bed by emphysema further contributes by increasing the pressure required to perfuse the pulmonary vascular bed. Cor pulmonale is associated with venous stasis and thrombosis that may result in pulmonary embolism. Another important systemic effect is the progressive loss of skeletal muscle mass, which contributes to exercise limitations and declining health status. 

Cor pulmonale Right-sided heart failure, usually due to structural lung disease (e.g., pulmonary fibrosis or emphysema). 

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. 

Vascular changes include thickening of pulmonary vessels that may lead to endothelial dysfunction of the pulmonary arteries. Later, structural changes increase pulmonary pressures, especially during exercise. In severe COPD, secondary pulmonary hypertension leads to right-sided heart failure (cor pulmonale). 

Commonly found in asbestosis are bilateral end-inspiratory pulmonary rales at the lung bases, dyspnea, finger clubbing, and cyanosis, but any or all of these symptom can be absent in any one case. Pulmonary hypertension is frequently associated with advanced asbestosis, and the resultant cor pulmonale (right-sided heart failure) may be the cause of death (Lemen et al., 1980, p. 2). 

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. 

The heart may also be affected in beriberi, with dilatation of arterioles, rapid blood flow, and increased pulse rate and pressure, and increased jugular venous pressure leading to right-sided heart failure and edema (so-caUed wet beriberi). 

Venous congestion (see chapters 14, 39) Budd-Chiari syndrome Constrictive pericarditis Right-sided heart failure... 

Swainsonine also induces high mountain disease, when the animals graze at high elevation, associated with congestive right-sided heart failure [157]. 

Right-sided congestive heart failure Portacaval shunt... 

The consequences of long-standing COPD and chronic hypoxemia include the development of secondary pulmonary hypertension that progresses slowly if appropriate treatment of COPD is not initiated. Pulmonary hypertension is the most common cardiovascular complication of COPD and can result in cor pulmonale, or right-sided heart failure. ... 

While arterial blood gas (ABGs) measurements are important, they do not carry the prognostic value of pulmonary function tests. Measurement of arterial blood gases is more useful in patients with severe disease and is recommended for aU patients with an FEVi of less than 40% of predicted or those with signs of respiratory failure or right-sided heart failure. ... 

Evidence of right-sided heart failure, polycythemia, or impaired neuropsychiatric function with a PaOj of less than 60 mm Hg... 

Pulmonary hypertension is a rare disorder, occurring with an approximate incidence of 1 to 2 cases per 1 milhon in the general population. With progression of the disease, right ventricular afterload increases, and the abihty to increase cardiac output with activity decreases. This progresses to right-sided heart failure and death. ... 

The drug and nondrug treatments of the most serious of pulmonary complications, including pulmonary hypertension, right-sided heart failure, respiratory failure, pneumothorax, and hemoptysis, are beyond the scope of this chapter. In general, the therapeutic approach does not vary snbstantively from that for other respiratory diseases. 

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