The symptomatology of right ventricular heart failure is clearly expressed, it is impossible to ignore it. The ability to recognize the symptoms of a disease that occurs at different stages allows you to avoid the development of dangerous complications leading to irreversible processes and death.
Symptoms of different stages
Right-sided heart failure is a chronic pathology. It occurs with dysfunction of the heart muscles in the right myocardium. If symptoms occur, the patient needs emergency medical attention. Those who know the signs of a dangerous disease immediately turn to the therapist.
The classification of pathology depends on the place of its localization. There are 2 types of heart failure:
- right ventricular (cor pulmonale);
- left ventricular.
Features:
| Disease type | Place of localization | Causes of occurrence | Consequences |
|---|---|---|---|
| Left ventricular | Affects the left myocardium. | It is caused by a decrease in coronary circulation, infectious diseases, tachycardia, arrhythmia. | The left ventricle is overloaded. In the pulmonary circle, blood circulation is stagnant. Causes cardiac asthma, pulmonary edema, cardiogenic shock. |
| Right ventricular | The functioning of the right myocardium is impaired. | It manifests itself in pulmonary thromboembolism, prolonged asthma, bilateral pneumonia, cor pulmonale, pericarditis. | The right ventricle is overloaded. Congestion occurs in the systemic circulation. Blood is abundant in the organs, but with difficulty it comes out of them. The liver enlarges, the legs swell, cyanosis occurs, and life-threatening complications develop in the lungs. |
There are 2 forms of pathology:
- chronic;
- acute right ventricular failure.
Right-sided insufficiency is a secondary disease. It is preceded by left ventricular heart failure. In most patients, right ventricular and left-sided insufficiency coexist. But cases are not excluded when heart failure on the right occurs in isolation.
In the early stages, the symptoms of the disease are caused by congestion in the pulmonary circulation. Right ventricular failure is accompanied by:
- tachycardia (spontaneous increase in heart rate);
- arterial hypotension (steady decrease in pressure);
- shortness of breath, lack of air;
- pressing pains in the region of the heart;
- swelling of the limbs;
- low temperature of the skin (coldness of the hands and feet);
- cyanosis (the skin in the area of the nasolabial triangle, arms and legs acquire a bluish tint);
- reduced skin turgor;
- swelling and pulsation of the jugular veins (in the supine position);
- high vascular permeability;
- pulmonary edema;
- nausea and vomiting syndrome;
- fainting;
- weakness, fatigue.
These symptoms are unchanged at all stages of the development of pathology. When right ventricular heart failure becomes complicated, it gets worse. Symptoms of stagnant blood in the systemic circulation are connected to them.
Patients suffer from:
- Feelings of heaviness and soreness in the right hypochondrium, arising from swelling of the liver.
- Hypertension.
- Edema.
- Oliguria - impaired blood flow in the kidneys.
- Decreased urine production caused by fluid retention.
- Cardiac asthma, provoked by an excess amount of blood in the venous vessels and capillaries of the lungs.
- Expansion and swelling of the cervical veins when lying and sitting.
- Mental disorders caused by impaired outflow of venous blood from the brain and oxygen deprivation.
- Gastritis and other diseases of the digestive system.
- Loss of appetite and weight.
- Ascites (excessive accumulation of fluid in the abdominal cavity).
- Hydrothorax (fluid effusion in the chest).
Location of edema
Puffiness is the first sign of right-sided heart failure. Edema is formed in organs remote from the heart:
- First of all, the swelling affects the lower extremities. First, the ankle area swells. Then the legs and thighs are involved in the pathological process.
- In severe forms of the disease, swelling, rising up the body, spreads along the abdominal wall.
- In men, swelling of the scrotum is noted.
- The hands, chest and neck area are drawn into the process.
- Swelling of the abdomen (ascites), chest cavity (hydrothorax) develops.
- Pulmonary edema occurs.
When the pressure in the left atrium and pulmonary capillaries rises to critical values, fluid begins to seep through the vascular walls. It fills the pulmonary vesicles and lumens.
With pulmonary edema, shortness of breath develops into dyspnea. The patient becomes agitated, assumes a forced sitting position that brings relief. The skin turns pale, the mucous membranes acquire a cyanotic (purple) hue.
The jugular veins swell. Tachycardia or arrhythmia develops. An intensified cough is accompanied by the separation of frothy sputum with blood inclusions. When listening, various moist rales are found. The doctor differentiates pulmonary edema from bronchial asthma. With its development, urgent diagnosis and immediate treatment are required.
At the beginning of the development of pathology, the legs and other parts of the body swell by the end of the day. Later, puffiness becomes a persistent phenomenon. It spreads throughout the body, causing anasartsi.
Fluid builds up in the bursa and abdomen, resulting in a frog's belly. Simultaneously, up to 1.5-2 liters of edematous fluid is collected in the abdomen.
Hydrothorax is a life-threatening complication. When 1 liter of fluid enters the pleura, the lungs are compressed, breathing becomes difficult, hypoxia and suffocation occur. Without emergency medical care, the patient has no chance of surviving.
According to the severity of the symptoms, the disease was divided into 3 stages. Each of them has its own symptomatology.
| Stage | Symptoms |
|---|---|
| Initial | With physical activity, shortness of breath occurs, heart rate increases. At rest, the pathology is asymptomatic. |
| Average | The legs are swollen. The patient suffers from shortness of breath and palpitations even at rest. There are 2 phases:
|
| Terminal | A severe, incurable form of the disease, in which irreversible pathological transformations have occurred in various organs. There is a violation of metabolic processes leading to exhaustion. |
In addition, the severity of the symptoms allows us to distinguish 4 more stages of the course of the disease:
| Degree | Signs |
|---|---|
| I | It passes hidden, without external signs. |
| II | Wheezing is noted. |
| III | The number of wheezing increases. |
| IV | The pressure drops to critical levels. Cardiogenic shock develops. |
Features of acute right ventricular failure
Exacerbation of the disease is caused by pathologies that unexpectedly limit the freedom of movement of blood flow in the pulmonary circulation.
The main factors provoking the development of an acute form of the disease include:
- protracted, severe asthmatic conditions;
- pulmonary embolism;
- blockage of the trachea or bronchi with a foreign body;
- pneumomediastinum;
- concentration of air in the pleural cavity;
- bilateral drainage pneumonia;
- collapse of the alveoli;
- effusion in the chest cavity;
- respiratory distress in infants;
- any pathologies that are accompanied by acute respiratory failure.
Acute right ventricular failure is formed with heart defects with reduced pulmonary circulation. Its appearance is provoked by the procedure of citrated blood transfusion, which is performed quickly, without introducing calcium and novocaine.
It develops when hypertensive injections or contrast agents intended for X-ray examination, when injected intravenously, are instantly infused. Accelerated administration of drugs causes increased resistance and vasospasm related to the pulmonary circulation.
The acute form of right-sided heart failure is accompanied by the following symptoms:
- swelling in the legs;
- shortness of breath;
- suffocation;
- cyanosis;
- sinus tachycardia;
- swollen veins in the neck;
- strong pulsation of the internal jugular vein;
- enlargement of the liver;
- the occurrence of pain in the right hypochondrium;
- disturbed heart rhythm;
- out of breath;
- tightness behind the breastbone;
- heart pains;
- the appearance of cold sweat on the skin;
- expansion of the right ventricle;
- weak pulse;
- an increase in central venous pressure;
- tachycardia.
Aggravation develops suddenly. When it appears, the symptoms of the disease dominate, which provoked the onset of right-sided heart failure.
Acute congestive manifestations that have arisen in the systemic circulation lead to renal failure. Blood biochemistry indicates impaired liver and kidney function.
Sometimes patients' blood pressure drops sharply, which causes shock. Due to poor blood circulation, cyanosis appears on the skin of the limbs.
If there are signs of exacerbation, you need to urgently call an ambulance. The rapid development of pathology ends in an irreversible process in the body - pulmonary edema. Death can be avoided if the doctor provides timely medical care to the patient.
Treatment
The method chosen by the attending physician will be based on the underlying cause of the heart failure. There are a number of drugs that are aimed at restoring myocardial contractile function and at reducing symptoms. If drug therapy has not brought the expected results, the patient is routinely prepared for surgery.
Therapy for heart failure of the right ventricular type should be prescribed by a cardiologist only after a thorough diagnosis of the patient. Many symptoms and clinical manifestations prevent the administration of certain groups of drugs. For example, with venous stasis in a large circle, with an increase in the liver, shortness of breath, swelling of the cervical veins, taking drugs belonging to the group of diuretics and vasodilators is contraindicated.
In the treatment, only weak diuretics are used in the minimum dosage established by the doctor. Vasodilators should not be used, because they reduce cardiac output, which further exacerbate the pathology.
After taking some drugs, the patient experiences refractory hypotension. in this case, intra-aortic counterpulsation, dopamine infusion, and circulatory support are applicable. In the same case, plasma or plasma substitutes are administered together with dobutamine and an arterial vasodilator to increase the preload on the right ventricle.
Right ventricular failure is a pathology that requires proper treatment and strict medical supervision. Knowledge of symptoms, timely access to a doctor and therapy are factors that prolong the life of patients, allowing them to return to their usual life.
