Right heart failure

Prostacyclin (epoprostanol) is one of the few drugs effective for the treatment of Primary Pulmonary Hypertension (PPH) a rare but frequently fatal illness of young adults. Increased blood pressure in the pulmonary circulation leads to right-heart failure. Continuous infusion of epoprostanol leads to a decrease in blood pressure however, it is unclear whether this is due to direct dilator activity of the IP receptor acting on smooth muscle, or a more indirect mechanism. 

FEVj < 30% or presence of chronic respiratory failure or right heart failure... 

Obtain spirometry measurements to assess airflow limitation and aid in severity classification and treatment decisions. Measure arterial blood gases if FEV is less than 40% predicted or if the patient has clinical signs suggestive of respiratory failure or right heart failure. 

Although heart disease commonly affects the entire myocardium, congestive heart failure is sometimes divided into left and right heart failure (Fig. 24—2). In left heart failure, the left atrium and ventricle are unable to adequately handle the blood returning from the lungs. This causes pressure to build up in the pulmonary veins, and fluid accumulates in the lungs. Consequently, left heart failure is associated with pulmonary edema (see Fig. 24—2 A). 

Elevation of y-GT is found in cholestasis, liver cirrhosis, viral hepatitis, fatty liver, porphyria, toxic liver damage, pancreatitis and pancreatic cancer, myocardial infarction, nephrotic syndrome, diabetes mellitus, right heart failure, obesity, nicotine abuse, and brain tumours. There is a good correlation of y-GT with CEA in colon cancer, involving a metastatic spread to the liver - an increase in y-GT in neoplastic disease is likewise supportive of the diagnosis of hepatic metastases. 

An increase in blood both in the sinusoids and in Disse s spaces culminates in hepatomegaly. This can be witnessed particularly in cases of right heart failure, constrictive pericarditis, veno-occlusive disease and the Budd-Chiari syndrome. Inflammation-related hyper-aemia also occurs in acute viral hepatitis. 

Liver cirrhosis (37), liver tumours, liver echinococcosis, portal vein thrombosis, thrombosis of the splenic vein, right heart failure, Budd-Chiari syndrome, peliosis hepatis (39), etc. 

Prognosis Prognosis is poor. The patients die of liver insufficiency or right heart failure as well as from various infectious diseases. The mean survival period after diagnosis was 15 months, with a 6-month mortality of 50%. 

Prognosis for PPH is poor the mean survival time is about 15 months with a 6-month mortality of 50%. The most common causes of death are right heart failure, dysrhythmia and infections. 

Aminocaproic acid has been reported to cause acute right heart failure (44). 

Johansson SA. Acute right heart failure during treatment with epsilon amino caproic acid (E-ACA). Acta Med Scand 1967 182(3) 331. ... 

A 30-year-old woman who had taken dexfenfluramine for 7 months developed pulmonary hypertension and right heart failure during late pregnancy. She died of septicemia with multiorgan failure 4 days after a cesarean section (60). 

Verapamil can cause cardiac failure, because it has a potent negative inotropic effect and causes increased capillary filtration pressure by vasodilatation (1). There are also reports of drug-induced acute right heart failure in patients with pulmonary hjtpertension due to valvular heart and chronic pulmonary obstructive airways diseases (2). 

Shimoni A, Maor-Kendler Y, Neuman Y. Verapamil-induced acute right heart failure. Am Heart J 1996 132(1 Pt 1) 193. ... 

Kruger S, Graf J, Merx MW, Stickel T, Kunz D, Hanrath P, et al. Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism. Am Heart J 2004 147 60-5. 

Cardiovascular Chronic right heart failure, Budd-Chiari syndrome, veno-occlusive disease... 

Kurzyna M, Dabrowski M, Bielecki D, et al. Atrial septostomy in treatment of end-stage right heart failure in patients with pulmonary hypertension. Chest 2007 131(4) 977—83. 

L. F. James R. J. Molyneux A. F. Alexander, Congestive Right Heart Failure in Cattle High Mountain Disease and Factors... 

Ng, C.Y. Angus, P.W. Ghabrial, H. Chou, S.T. Amolda, L. Morgan, D.J. Smallwood, R.A. Right heart failure impairs hepatic oxygenation and theophylline clearance in rats. J.Pharm.Exp.Then, 1995, 273, 1332-1336... 

---