Right ventricular failure: stages and symptoms, treatment of acute and chronic forms, life prognosis. Acute right ventricular failure

One of the most terrible diagnoses in cardiology is heart failure. The disease is chronic, so the patient must learn to live with his condition, avoiding relapses. There are left ventricular and right ventricular heart failure, but attention should be paid to damage to the right myocardium.

This heart disease most often prevails in retirement age, and progresses against the background of existing myocardial diseases. There are no restrictions based on gender, so the characteristic form of heart failure progresses equally in female and male bodies.

If, with damage to the left part of the myocardium, blood stagnation is formed in the small circle, then with right ventricular heart failure this abnormal phenomenon predominates in the large circle of the general blood flow. As a result, irreversible changes occur in the lungs, fraught with swelling of this vital organ. There are several reasons for this pathological process, but doctors explain this by the fact that for certain reasons, overload of the right ventricle predominates.

If we study in detail the etiology of heart failure, then this form of the disease is caused by the presence of pulmonary hypertension in the affected body. This diagnosis can also be preceded by other diseases of the cardiovascular system, represented by arterial hypertension, cardiac ischemia, atherosclerosis, myocardial infarction, stroke and vascular dystrophy. Accordingly, it is important to prevent detailed relapses, otherwise the patient’s death cannot be ruled out.

Right ventricular chronic heart failure with obvious manifestations of dystrophy is considered the final stage of a characteristic pathological process, and prescribed resuscitation measures are not always able to stabilize the general condition. So it is important to know the symptoms of this diagnosis, otherwise the lack of timely treatment may result in disability and mortality.

Symptoms

All heart diseases are characterized by relapses, which prompt alarming thoughts about the presence of problems with the functioning of the heart muscle and vascular system. The signs in such clinical pictures are clearly expressed, so it is simply impossible not to pay attention to them.

It all starts with a pressing sensation in the sternum, which increases almost every hour. In addition to such painful sensations, a sick person experiences an acute lack of oxygen and an attack of dizziness. Vomiting is less common, fainting and instability of blood pressure predominate.

If we talk about eloquent signs of right ventricular heart failure, they are represented by swelling not only of the lower extremities, but also of the arms, face, neck and upper chest.

In addition, the skin changes color, becoming noticeably paler and becoming flabby. However, the first sign was attacks of suffocation, progressing mainly at night. Sometimes this condition can be confused with attacks of bronchial asthma, which is why right ventricular heart failure is also called “cardiac asthma.”

As for the blood pressure indicator, its value depends on a number of additional signs of the disease: during a hypertensive crisis it increases, and during myocardial infarction it rapidly decreases. Gradually, the progression of heart failure provokes pulmonary edema, which can be fatal.

Diagnostics

It is impossible to determine the disease on your own, but a doctor can do this after a detailed diagnosis. In this clinical picture, clinical examinations include ECG, ultrasound, MRI and chest x-ray, and laboratory tests include general and biochemical blood tests, and urinalysis.

Thus, an ECG demonstrates acute overload of the right side of the heart, ultrasound allows one to determine changes and neoplasms in the myocardium, and MRI is appropriate in difficult clinical situations. A general blood test shows the number of leukocytes and, accordingly, the degree of progression of the inflammatory process; and biochemical - the state of hormonal levels and the presence of a potential threat to health.

When all the results of the tests and examination are in the hands of the specialist, after a re-examination and examination of the patient’s complaints, an accurate diagnosis can be made and an adequate treatment method can be prescribed. If there are difficulties in making a diagnosis, then X-rays and MRIs are also required.

Prevention

Of course, sometimes it is simply impossible to avoid heart disease, especially when it comes to genetic predisposition. However, once you find yourself in a risk group, it is important not to forget about preventive measures. As a rule, right ventricular heart failure progresses against the background of the underlying disease, which is why the task of prevention is to promptly prevent a relapse of a chronic pathological process and maintain a period of remission for as long as possible.

For these purposes, proper nutrition, emotional calm, an active lifestyle, cardio exercise, weight control and a regular course of drug therapy are required. In the latter case, you should not take unknown medications; in any case, it is important to first consult with your treating cardiologist.

Treatment

If we talk about intensive care, its task is to save the patient’s life and maintain his ability to work. For these purposes, drug and surgical treatment are specifically provided, and in the latter case, the testimony of a specialist is required to perform the operation.

Drug therapy should be timely and early, and be distinguished by its adequacy. That is why a patient in the relapse stage is immediately hospitalized, thereby providing round-the-clock clinical and laboratory-instrumental control.

Doctors set themselves the task of normalizing blood circulation, both in the small and large circles, while stabilizing it by normalizing the pumping function of the myocardium. In such clinical situations, beta blockers, anticoagulants, painkillers, vasodilators and restorative drugs are prescribed, but their daily dosage is determined on an individual basis.

If the disease is accompanied by complications, it is important to prevent pulmonary edema, arrhythmia, acidosis and restore tissue perfusion. It is sometimes very difficult to achieve a positive therapeutic effect, so cardiac surgeons have no choice but to perform the operation. This requires detailed diagnosis and testimony from a doctor, otherwise a medical error can become fatal in the future.

Such surgical procedures are life-threatening and require high professionalism, and the rehabilitation period is very long. The consequences of a typical operation can be the most unpredictable, especially since they do not cure heart disease completely. The recovery period sometimes lasts for more than one year, and it significantly reduces overall performance.

Right ventricular failure is a pathology associated with damage to a section of the heart muscle localized in the right side of the heart. Considering that the right section is connected to the lungs, we have a malfunction in the pulmonary circulation.

Damaged heart muscle does not ensure complete expulsion of blood into the pulmonary artery. However, blood continues to be pumped into the right side of the heart, which leads to a gradual stretching of the wall of the right atrium with the chamber overflowing with blood.

As a result, first the small pulmonary vessels, and then the pulmonary artery, begin to feel an increase in intravascular pressure. Blood stagnation develops in the internal organs. The liver begins to enlarge, swelling appears on the lower extremities.

In the recent past, right ventricular failure (RF) was identified as a separate, differentiated disease. For a long time, insufficient functioning of the heart was associated with various pathological processes occurring in the left ventricle.

For reference. As it turned out, the functioning of the right and left chambers of the heart is significantly different, as is their anatomical configuration. It was found that right ventricular failure is formed when normal blood circulation in the pulmonary hemocirculation is disrupted, when the muscle fibers of the right ventricle do not work fully. Many doctors call this disease “cor pulmonale.”

This pathology is detected much less frequently than, but it poses no less a danger to the patient’s health. It must be detected in time and proper treatment prescribed to improve the prognosis of the disease and the patient’s quality of life.

Right ventricular failure - causes

Pathology can occur acutely or chronically. The acute type of right ventricular failure affects people with the following diseases:

• Thromboembolic syndrome of the pulmonary artery in a wide form.
• Pneumothorax is compression of the lung by air located in the pleural cavity.
• Paroxysm of respiratory failure.
• Acute, extensive form of pneumonia.
• Infarction of the muscular lining of the heart (transmural, or extensive).
• Inflammatory process in the myocardium.
• Rupture of the interventricular septum.
• Severe, prolonged paroxysm of bronchial asthma in the presence of status asthmaticus.
• Acute attack of broncho-obstructive syndrome.
• Hydrothorax is compression of the lung by fluid.

The chronic form of right ventricular dysfunction occurs when:

• Diseases of the respiratory tract: inflammation of the bronchi, asthma, emphysema, bronchiectasis, sarcoidosis and others.
• Pathologies of the spinal column in which the dynamics of the chest are disturbed: curvature of the spine, ankylosing spondylitis.
• Pathological excess weight, leading to insufficient movement of the chest.
• Heart defects that cause overload of the right ventricle - tricuspid valve insufficiency and others.
• Viral spinal paralysis, systemic diseases that cause damage to the connection between the nervous and muscular systems.
• Disturbances occurring in the pulmonary bloodstream - increased pressure in the pulmonary artery, the presence of blood clots, arteritis, malignant neoplasms, enlargement of the aorta.

Attention. Sometimes left ventricular failure occurs primarily and causes the formation of right ventricular failure. This is explained by the fact that during the first disease, the pressure in the pulmonary artery increases, which provokes excessive load on the right chamber of the heart, and as a result, the formation of PN.

Right ventricular failure - symptoms

The very first symptoms of right ventricular failure are:

• constant increase in heart rate,
• swelling of the lower extremities,
• hepatomegaly (enlarged liver).

The swelling of the lower layers of the skin gradually becomes more pronounced, and it begins to move upward, to the thigh and lumbar areas, the abdomen, and sometimes to the arms.

For reference. Edema tends to move in a lower direction, which is why in patients with a sedentary lifestyle, fluid accumulates on the lower extremities, and in those who are lying down, on the lower back.

There is also an accumulation of fluid in the pleural cavity, and it can be present only on one side or on both sides at once. Swelling of the abdomen is usually found in patients who have suffered from PN for a long time.

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If right ventricular failure has developed due to an inflammatory process in the pericardium, accompanied by compaction of its inner layer, swelling of the abdominal cavity is much more pronounced and develops much earlier. The accumulation of fluid in the pericardium does not manifest itself too strongly, so it is not clinically detected.

When examining a patient, the doctor observes hepatomegaly; during palpation of the liver, the person feels pain.

For reference. Severe pain under the right ribs is caused by expansion of the liver membrane; they are characteristic of dynamically progressing right ventricular failure. In addition, the patient experiences a feeling of heaviness in this area.

The functioning of the liver remains within normal limits, but sometimes there are cases of increased concentration of bilirubin in the blood. If PN has a very long course, the formation of cardiac cirrhosis is possible, and in some patients - jaundice. Less commonly, right ventricular failure causes death of areas of the liver, insufficient liver function and extensive jaundice.

For reference. Vivid symptoms of right ventricular failure:

• low local temperature of the legs and arms,
• blue skin,
• increase in the cervical venous network.

At first, the veins enlarge only when the patient is lying down. Gradually this manifests itself in a sitting position. When the doctor palpates the liver, the pressure in the veins increases and the cervical venous network swells. The duration of blood flow in circles is increased.

One of the symptoms is also the release of most of the daily urine at night, as well as a reduced amount of urine excreted. A certain concentration of proteins is also found in the urine. The patient also experiences a decrease in appetite and pain in the epigastric region. Sometimes signs of oxygen starvation of the brain are detected.

Diagnostics

As a rule, clinical symptoms clearly indicate the presence of right ventricular failure. But still, to make a diagnosis, the patient must be referred for additional examination.

All diagnostic procedures should be performed in a hospital, since the pathology is quite insidious, and at any moment there may be a need for emergency medical care.

The following diagnostic measures are carried out as a priority:

• Electrocardiographic study. Indicators of right ventricular overload are recorded: T waves have a negative value in the right precordial leads, as well as at the lower border of the LV. There is also complete or relative blocking of the right bundle branch, signs of thromboembolic syndrome - the S wave has a greater depth in the first lead, and the Q wave in the third lead. Also, the electrocardiogram always shows a high P wave with a sharp end in all leads, which indicates excessive work of the right atrium.
• X-ray examination of the breast organs. Allows you to detect the accumulation of exudate or air in the pleural cavity, swelling of the lungs, as well as inflammation.
• Ultrasound examination provides accurate information if there is stagnation of blood in the hepatic vessels, when pain under the right ribs is the only symptom of PN.

When the patient is admitted to the hospital, an echocardioscopy examination, Holter monitoring, constant monitoring of blood pressure, a blood test for troponins, creatine kinase, D-dimers, and an examination of respiratory function are performed - in the presence of broncho-obstructive syndrome or bronchial asthma.

For reference. Diagnosis is usually made after an ECG and radiographic examination and based on the medical history. Other diagnostic methods are prescribed on an individual basis and depend on the leading diseases.

Acute right ventricular failure - features

The acute form is provoked by conditions when the movement of blood in a small circle of the blood flow is sharply hampered. What can affect the deterioration of blood flow in this area:

• Asthmatic status;
• Thromboembolic pulmonary artery syndrome;
• Mediastinal emphysema;
• Collapse of the alveoli;
• Exudate in the chest cavity;
• Respiratory disorders in newborns;
• Shortness of breath.

Symptoms of acute right ventricular failure

Exacerbation is characterized by the following symptoms:

• swelling of the lower extremities;
• dyspnea;
• asphyxia;
• blue skin;
• sinus increased heart rate;
• swelling of the cervical venous network;
• hepatomegaly;
• arrhythmia;
• pain on the right under the ribs;
• respiratory disorders;
• cold sweat;
• stretching of the membranes of the right ventricle;
• increased central pressure in the veins;
• promotion Heart rate .

For reference. The disease develops completely unexpectedly. Initially, the patient complains of symptoms of the disease that caused the formation of an acute form of PN. Stagnation of blood in the systemic circle causes failure of renal function. Liver function is also impaired.

Sometimes there is a sudden decrease in blood pressure, which causes a state of shock. Due to obstructed blood flow, acrocyanosis is detected.

If we suddenly talk about any type of heart failure, most often people talk about the left ventricular type. The significance of the right ventricle was fully elucidated by scientists not so long ago.

Failures in its work associated with impaired myocardial functionality are collectively called “pulmonary heart”, since there is a disturbance in blood flow in the pulmonary circulation.

Causes

Doctors distinguish several types of heart failure, the development of each of which is due to a number of reasons characteristic of a particular type.

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For example, the following reasons are typical for the acute development of cor pulmonale:

• extensive blockage of a pulmonary artery by a thrombus;
• tension pneumothorax of valvular nature;
• severe bronchial asthma;
• acute pneumonia with total damage to both lungs;
• mocarditis is an inflammatory process in the heart muscle;
• damage to the septum separating the ventricles.

Chronic right ventricular heart failure develops due to the influence of the following factors:

If the heart is affected primarily by insufficiency of the left stomach, then over time right ventricular failure also joins and is then secondary. This happens due to the so-called decompensation process.

Decompensation is characterized by high pulmonary artery pressures and, therefore, excessive impact on the right ventricle and atrium.

Signs of right ventricular heart failure

Signs of right ventricular failure are primarily based on disruptions in the functioning of the systemic circulation. The typical symptoms are:

Treatment

The treatment regimen is selected by medical professionals depending on the form of the disease.

If a patient has an acute attack, then it is necessary first to eliminate the factors that provoked its development:

• using any methods, a blood clot is removed from the affected vessel, blood flow in the affected area is restored;
• reduce pressure in the pulmonary circulation and pulmonary arteries using aminophylline and gnaglial blockers;
• if the cause of cor pulmonale is pneumonia, antibiotics are selected;
• if the cause is pneumothorax, first eliminate the pneumothorax using drainage, and then treat heart failure;
• if status asthmaticus develops, glucocorticosteroids are prescribed.

With acute pathology, the patient is hospitalized in a hospital and placed in intensive care.

Naturally, if the deficiency is chronic, the treatment regimen will be completely different. The main goal for chronic insufficiency is to reduce the amount of stagnant blood in a large circle, a general decrease in the volume of circulating blood.

Most often, in order to reduce blood volume, doctors prescribe diuretic therapy.

Surgery is most often used for congenital heart defects.

Honey medications for right ventricular heart failure, aimed at reducing pressure in the pulmonary artery:

• control of weight indicators;
• exclusion from the diet of fried, salted, smoked foods, reducing salt and water consumption;
• after consultation with a doctor, perform physical exercises and avoid a completely sedentary lifestyle;
• rejection of bad habits.

Atrial fibrillation, which often accompanies chronic right ventricular heart failure, requires the use of drugs from the group of cardiac glycosides. For example, digoxin is prescribed.

Predicting the course of the disease takes into account not only the severity of the course and concomitant diseases, but also the general condition of the organs that experience the greatest load due to insufficiency. Repeated thromboembolism and primary elevated pressure in the pulmonary artery justify the most unfavorable prognosis.

If chronic pathology enters the stage of decompensation, then the most optimal prognosis is another 3-5 years of life.

Doctors also distinguish such a thing as isolated right ventricular failure. It began to be studied in detail not so long ago. The development of an isolated disease can be explained not only by the pathological functioning of the right ventricle and blood vessels, but also by diseases of the respiratory system.

Patients with chronic diseases of the respiratory tract should pay special attention to the condition of their heart, since respiratory pathologies automatically “pull” along with them such a complication as cor pulmonale, which, although not immediately, almost always develops in patients.

This complication is especially frequent and severe in those patients who do not treat diseases of the respiratory system, letting them take their course.

Much less common is a primary deficiency, which in most cases is explained by congenital defects and is eliminated surgically along with the defect.

In all these cases, the use of diuretics and vasodilators is contraindicated. After the administration of diuretics or vasodilators, a decrease in blood pressure always occurs, up to severe hypotension or shock. When blood pressure decreases, intravenous fluid administration is indicated (plasma replacement solutions at a rate that ensures blood pressure is maintained at 90-100 mm Hg). If the effect is insufficient, dobutamine infusion is used. Milrinone may be used.

In cases of severe refractory hypotension - infusion of dopamine, norepinephrine, intra-aortic counterpulsation, assisted circulation.

Treatment uses diuretics, including spironolactone, and sometimes a short course of dopamine in a low (“diuretic”) dose.

With the development of right ventricular failure, venous vasodilators are contraindicated, since they, by reducing venous return, reduce cardiac output.

To correct arterial hypotension in right ventricular failure, administration of plasma substitutes or plasma is indicated to increase preload on the right ventricle in combination with dobutamine and arterial vasodilators (hydralazine or phentolamine).

Dobutamine in combination with phentolamine causes vasodilation of peripheral arteries, reduces afterload on the left ventricle, pressure in the left atrium and pulmonary artery. This leads to a decrease in afterload on the right ventricle and an increase in its output.

Stroke output can also be increased by injecting fluid directly into the pulmonary artery.

For pulmonary infection and bacterial endocarditis, the use of antibiotics is indicated.

Treatment of primary pulmonary hypertension is with calcium antagonists, nitric oxide, or prostaglandins.

With the development of pulmonary embolism, thrombolytic therapy and, if indicated, thrombectomy are performed.

Acute right ventricular failure is treated based on the treatment of the underlying disease: for pulmonary embolism - heparin and thrombolytic therapy, for tamponade - pericardiocentesis and drainage of the pericardial cavity, for myocardial infarction - thrombolytic therapy or surgical treatment.

Right ventricular failure as an independent pathology was identified relatively recently. Previously, heart failure meant disorders associated with left ventricular dysfunction. But recent research by scientists has made it possible to see a significant difference between the work of the right and left departments of the main organ. Right ventricular heart failure occurs due to impaired blood flow in the pulmonary circle, as a result of myocardial dysfunction. The pathology is often called “pulmonary heart”.

Causes of the disease

Right ventricular failure can be acute or chronic, occurring as an independent disease or as a consequence of another disorder occurring in the body. The causes of right ventricular failure are varied. Pathology can occur as a result of:

• extensive;
• valvular tension pneumothorax;
• acute attack of respiratory failure;
• extensive acute pneumonia;
• with myocardial infarction;
• pathology such as myocarditis.

This disease can develop against the background of respiratory pathologies (emphysema, bronchial asthma, bronchitis, as a result of sarcoidosis), scoliosis, polio, and autoimmune diseases. The disease can occur as a result of thromboembolism, vasculitis, tumors.

In the case of the development of right ventricular failure, the causes of the disease may be associated with congenital heart defects, severe obesity, which reduces the amplitude of movement of the diaphragm. may cause the right ventricular form of pathology.

Manifestations and symptoms of the disease

Right ventricular heart failure is characterized by certain symptoms, which are more pronounced during the acute period of the disease. The main signs of the disease may appear as:

• rapid heartbeat;
• arterial hypotension;
• shortness of breath and difficulty breathing;
• swelling of the respiratory organs;
• pulsation and swelling of the jugular veins;
• acrocyanosis.

With stagnation of blood, other signs are added, which manifest themselves in the form of an enlarged liver, discomfort in the right hypochondrium, swelling of the legs and the anterior part of the peritoneum. Fluid may accumulate in the chest cavity and peritoneum and blood circulation in the kidneys may be impaired.

Right ventricular failure can manifest itself as chronic hypertension, gastritis, and mental disorders. Only a doctor can determine the exact cause after a thorough examination of the body.

Right ventricular failure can occur in a chronic form, and the main sign of the pathology is often edema, which may initially be small and occur in the form of an increase in body weight and a decrease in urine output. Swelling manifests itself to a greater extent in the area of ​​the feet and legs, and as the pathology increases, it spreads to the area of ​​the hips, lower back, and abdominal wall.

A person with this disease quickly gets tired, physical and mental performance decreases. The patient may be irritable, suffer from insomnia, and be depressed (with low cardiac output, decreased blood supply to the brain, and disturbances in the functioning of the central nervous system). Congestive gastritis and functional liver disorders, which are a consequence of the disease, will give characteristic symptoms in the form of nausea, vomiting, bloating, and constipation.

Signs of the disease are yellowness of the skin, renal edema, swelling of the veins in the neck. A person may experience both a sharp weight gain and severe weight loss, which is a consequence of progressive heart failure. The skin of the legs is affected by trophic ulcers.

Diagnosis and treatment of pathology

The heart is one of the main organs in the human body, a motor without which a person cannot live. Diseases of the cardiovascular system often lead to death, so it is very important to promptly identify the disease and begin its treatment with medications.

Comprehensive, aimed at eliminating the main cause, symptomatic therapy is used, which will help eliminate painful symptoms.

It is quite difficult to identify right-sided heart failure because it rarely manifests itself as an independent disease. It is very important for a person who periodically or constantly experiences symptoms associated with cardiac dysfunction to consult a doctor and undergo a series of tests.

An electrocardiogram is the procedure by which left or right ventricular failure can be determined. To clarify and confirm the diagnosis, ultrasound, MRI, and x-rays are prescribed. Additionally, the patient will need to have blood tested for a comprehensive study.

If acute deficiency is observed, it is necessary to urgently find out and eliminate its cause:

• dissolve or promptly remove a blood clot from the pulmonary artery;
• reduce pulmonary hypertension using Eufillin and ganglion blockers;
• treat shock using sympathomimetics and intravenous solutions;
• restore blood flow through the arteries if the cause of insufficiency is a heart attack;
• antibacterial agents are prescribed for pneumonia;
• Taking glucocorticosteroids is indicated for an asthmatic attack.

If chronic right ventricular failure is observed, then therapy will be aimed at reducing blood stasis with the help of diuretics. For congenital heart defects, surgical intervention, including organ transplantation, is often indicated. Medications are prescribed to relieve symptoms of the disease.

The survival prognosis for patients with right ventricular heart failure depends on the cause that provoked the development of the pathology. In the most severe cases (PE) this period ranges from 3 to 5 years.

Disease prevention

Keeping the heart healthy is important for every person, because not only the quality of life, but also its duration depends on it. There is no separate prevention specifically for right ventricular failure. All the rules are the same as for preventing cardiac diseases in general.

In particular, a person is recommended to lead a healthy lifestyle. This includes giving up smoking, alcoholic drinks, and fatty foods. Be sure to walk in the fresh air and do simple physical exercises. Frequent stress and depression greatly worsen the functioning of the heart, so you need to avoid such conditions as much as possible, treating all life’s troubles calmly.

With heart disease, any emotional outbursts are very harmful and dangerous. This applies not only to negative, but also to positive emotions that arise while watching your favorite football match, for example. Life should be smooth, measured, without emotional and physical outbursts. In addition to not being nervous, it is forbidden to walk quickly, run, or do heavy physical work. You cannot load the left side of the body or the left limb for a long time and heavily (sawing, chopping, lifting heavy objects).

It is necessary to eat properly and in small portions. It is important. You need to eat often, but the portions should be small. The diet can include absolutely all foods - vegetables, fruits, meat, fish, herbs, all kinds of cereals, fermented milk foods. The main thing is to cook them correctly, by steaming, boiling or in the oven. You should control your salt intake, which should be very small in your diet. Salt retains fluid in the tissues, which can worsen the patient’s condition and lead to the development of edema.

Heart disease is dangerous, but with the right routine - calm and measured, a person can lead a fairly high-quality lifestyle and live for a long time.

It is important to conduct an examination of the organ in the hospital every six months using ultrasound and ECG. If the condition worsens, you should contact a specialist immediately.

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