Right-Sided Heart Failure, Its Morphology And Clinical Features In Full Detail
Right heart failure is usually the result of left heart failure, as any increase in pressure in the pulmonary circulation inevitably leads to an increase in the load on the right heart. Thus, the causes of right ventricular heart failure include all the causes of left ventricular failure. Isolated right ventricular failure is rare and usually occurs in patients with various lung diseases. Hence it is often called core pulmonary.
In addition to pulmonary parenchyma disease, the core pulmonary can also result from disorders affecting the pulmonary blood vessels, such as primary pulmonary hypertension, recurrent pulmonary thrombo embolism, or conditions that cause pulmonary vasoconstriction (sleep deprivation).
A common feature of the disease is pulmonary hypertension, which leads to hypertrophy and right heart enlargement. In the core pulmonary, hypertrophy and myocardial proliferation are usually limited to the right ventricle and atrium, although dilation of the left ventricle of the intraventricular septum may reduce cardiac output, leading to obstruction of the outlet.
The basic morphological and clinical manifestations of right ventricular heart failure differ only from left ventricular failure because most portal and systemic venous systems appear normal, and lung congestion is minimal.
Morphology
Liver system and portals. The liver usually increases in size and weight (congestive hepatomegaly). On the horizontal side, a clear passive stasis is visible, an image called the nutmeg heart. The dense centrilobular area is surrounded by a light, non-congestive peripheral parenchyma.
When left ventricular heart failure is also present, in addition to centriolobular necrosis resulting in severe central hypoxia. With prolonged acute right ventricular failure, the central region may become fibrotic, known as cardiac cirrhosis.
Right heart failure can also cause an increase in pressure in the portal vein and its tributaries (portal hypertension) with vascular congestion, resulting in a wide and tense spleen (congestive splenomegaly). In severe cases, chronic dysfunction and consequent inflammation of the intestinal wall can interfere with the absorption of nutrients and medications.
Pleural, pericardial and peritoneal spaces. Congestive heart failure due to right-sided heart failure can cause transudate (impact) in the lungs and pericardial cavities, but does not usually cause inflammation of the lung parenchyma.
Pleural effusion is more pronounced with a combination of right and left ventricular heart failure, leading to an increase in pulmonary and systemic venous pressure.
Congestion (with or without depleted albumin synthesis) and portal hypertension can cause peritoneal transudation (skin). In the absence of complications, right-sided flow is associated with CHF.
Transudates with low protein content and absence of inflammatory cells.
Subcutaneous Tissue
Swelling of the body parts, especially the legs and feet, is a hallmark of right-sided CHF. In patients with chronic bedwetting, edema may be particularly presacral.
Clinical Features
Unlike left-sided heart failure, purely right-sided heart failure is not usually associated with respiratory symptoms. In contrast, clinical manifestations are associated with portal and systemic venous congestion and include enlargement of the liver and spleen, peripheral edema, pleural effusion, and ascites. Right ventricular failure can cause venous stagnation and hypoxia of the kidneys and brain.
It causes a deficit in left-sided heart failure due to hypoperfusion. It should be noted that cardiac decompensation is often manifested by the appearance of bicentricular heart failure, which includes features of right and left heart failure. As CHF develops, a decrease in tissue perfusion in patients can lead to marked cyanosis and ascites, both a decrease in cardiac output and an increase in blood stasis.
Summary
Heart Failure
- CHF occurs when the heart cannot provide enough perfusion to meet the metabolic needs of peripheral tissues. Inadequate cardiac output is often associated with venous thrombosis.
- Left-sided heart failure is usually caused by ischemic heart disease, systemic hypertension, aortic or mitral valve disease, or primary myocardial disease. Symptoms are mainly due to pulmonary congestion and inflammation, although systemic hypoperfusion can cause kidney and brain disorders.
- Right-sided heart failure is often caused by left-sided heart failure and is less common than primary lung disease. Signs and symptoms are mainly associated with peripheral edema and neuralgia.