Right-Sided Heart Failure: A Case Study

Heart failure may convey that the heart isn’t working anymore, but what it really means is that the heart isn’t pumping as well as it should be (REF). Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through to meet the body’s needs for blood and oxygen (REF). At first, the heart tries to make up for this by enlarging, developing more muscle mass, and pumping faster. As this happens, the blood vessels narrow to keep blood pressure up and the body diverts blood away from less important tissues and organs to maintain flow to the heart and brain (REF). Eventually, the body and heart cannot keep up and the patient begins to feel fatigue, breathing problems, weight gain with swelling in the feet, legs, ankles or stomach, and other symptoms that eventually leads to a hospital visit. The body’s coping mechanisms give us better understanding on why many are unaware of their condition until years after the heart declines (REF).

Heart failure can be attributed to either right sided, left or both. Left-sided heart failure is of two types, systolic failure and diastolic failure. Systolic failure is the when the left ventricle loses its ability to contract normally. The heart cannot pump with enough force to push enough blood into circulation. Diastolic failure is when the left ventricle loses its ability to relax normally. Which results in the heart not being able to fill with blood during the resting period. Both result in a decrease in cardiac output. (AHA, 2012). A decrease in the cardiac output into the systemic circulation causes blood to accumulate in the left ventricle, left atrium, and pulmonary circulation. This increase

right-sided CHF = fluid may back up into your abdomen, legs and feet, causing swelling.

6. What laboratory tests should be ordered for M.G. related to the order for furosemide (Lasix)? (Select all that apply)

After a period of time, the heart muscles of the left ventricle begin to weaken. The weakening of the left ventricle will lead to decreased empting of the heart (systolic heart failure) which results in decreased cardiac output again. Since the left ventricle does not empty completely, blood begins to back up into the left atrium and then to the pulmonary circulation thus resulting in pulmonary congestion and dyspnea (Story 2012, 104). If left untreated, the blood will back up and affect the right side of the heart causing biventricular heart failure (both right and left heart failure). In right sided heart failure, the right ventricle weakens and cannot empty completely. This incomplete emptying causes blood to back up into the systemic circulation causing systemic edema (Lewis et al. 2014, 771).

Although these interventions may improve immediate survival in the short term, only coronary artery revascularization and cardiac transplantation have been shown to improve long-term survival.” (DeMarco & Chatterjee, 1993)

There are many causes for heart failure. The most common cause is coronary heart disease (Moore and Roth, 2015). CHD is a disease in which the coronary arteries are blocked, preventing the heart muscles from getting the oxygenated blood they need. Heart failure can be caused by other present or past conditions like high blood pressure, diabetes, abnormal heart valves, diseased heart muscle, irregular heartbeats, heart defects, serious lung disease, poisons or substance abuse, and sleep apnea (Heart Failure Overview).

Diastolic heart failure or diastolic dysfunction is when the left ventricle does not relax normally. This pushes the heart to pump too quickly, permitting the heart from filling the chamber with enough blood during the resting period betweens beats (Types of Heart Failure). Right-sided heart failure is usually a consequence of left-sided heart failure. When the heart loses its main source of pumping power, the right side of the heart is affected by blood being pushed into the veins of the body causing swelling. These heart conditions can be ongoing or they can start abruptly which can have a huge impact on the body (Types of Heart Failure).

Congestive Heart Failure is when the heart's pumping power is weaker than normal. It does not mean the heart has stopped working. The blood moves through the heart and body at a slower rate, and pressure in the heart increases. This means; the heart cannot pump enough oxygen and nutrients to meet the body's needs. The chambers of the heart respond by stretching to hold more blood to pump through the body or by becoming more stiff and thickened. This only keeps the blood moving for a short while. The heart muscle walls weaken and are unable to pump as strongly. This makes the kidneys respond by causing the body to retain fluid and sodium. When the body builds up with fluids, it becomes congested. Many conditions can cause heart

Left-sided heart failure occurs when there is damage to the left ventricle. The damage may be due to, for example: high blood pressure, drug abuse, heart attack,

To understand the signs and symptoms of left-sided versus right-sided heart failure, remember that left-sided signs and symptoms are found in the lungs. Left begins with L, as does lung. Any signs and symptoms not related to the lungs are caused by right-sided failure (Williams and Hopper). Some signs and symptoms of heart failure are shortness of breath (dyspnea), fatigue, chronic cough or wheezing, rapid or irregular heartbeat, lack of appetite or nausea, mental confusion or impaired thinking, fluid buildup and swelling, and rapid weight gain, and the need to urinate more at night. In order to determine heart failure the physician will do a diagnostic test which includes a chest x-ray, echocardiogram, ejection fraction (EF), and electrocardiogram (EKG or ECG).

In right sided heart failure, fluid builds up in the veins and tissues, causing swelling of the lower extremities and the abdomen. When body tissues fail to get the oxygen and the nutrients they require, they begin to lose their efficiency, causing increased dizziness and fatigue.

It involves the tightening of blood vessels connected to and within the lugs. This makes it harder for the heart to pump blood thorough the lungs, much as it is harder to make water flow through a narrow pipe as opposed to a wide one. Over time, the affected blood vessels become both stiffer and thicker, further increasing the blood pressure within the lungs and impairing blood flow. In addition, the increase workload of the heart causes thickening and enlargement of the right ventricle, making the heart less able to pump blood through the lungs, causing right heart failure. As the blood flowing through the lungs decreases, the left side of the heart receives less blood. This blood may also carry less oxygen than normal. Therefore it becomes harder and harder for the left side of the heart to pump to supply sufficient oxygen to the rest of the body, especially during physical activity.

Heart failure describes the heart’s inability to function properly, meaning the heart is unable to pump efficiently throughout the body. Thus causing the heart to work extra hard in order to compensate the body’s needs, but this ultimately leads to failure. And due to Mrs. Harris’s hypertension and alcohol consumption, she is now displaying signs and symptoms of congestive heart failure, as both are major risk factors. Heart failure can be seen in the left side, which is also known as congestive heart failure, and the right side of heart. The left side is typically the first side to fail, as the left ventricle is the heart’s largest chamber and the most powerful.

I am a NP currently working for a Hospital Medicine group in an inpatient setting. My primary job responsibilities are to admit patients into the hospital, round on patients, provide cross cover on the patients on our service, provide cross cover on inpatients who our group is consulted to see, respond to rapid response codes, and occasionally discharge patients.