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Right heart failure (mechanism and symptom): Definition

See also heart failure (advice), bloodstream. Synonym: heart failure inability of the heart more specifically the right side of it (right ventricle) to perform its function of a pump to propel blood. Heart failure affects about 1% of the population age 50 and 10% after 80 years an estimated 17 million people worldwide suffering from chronic heart failure. The right heart failure is most often secondary to left heart failure. Specifically chronic heart failure is defined as a set of complex symptoms that occur during a period in which the heart cannot assume a flow rate (minimum amount of blood ejected) sufficient and necessary to the normal needs of all body tissues. More precisely it is the ventricles (left and right) that ensure the ejection of blood from the heart.

The blood circulates in a closed circuit in the blood vessels, arranged in two vascular loops: the systemic circulation that distributes blood to organs and tissues and the small circulation which feeds exclusively lungs. The heart is located between these two systems, will serve as the engine of the circulatory system, it divides it into two parts, a left heart and right heart.

The left heart receives oxygenated blood (or arterial) from the small circulation and blows it into the aorta is the largest artery in the body. The aorta is somehow a starting point of the general circulation, which is the main artery. It carries blood to the organs by successive ramifications. Recent arteries called arterioles (arteries microscopic) finally distribute blood to the deeper tissues (all cells constituting an organ). These arteries possess elasticity, which allows them to reduce fluctuations in blood pressure. They will regulate the pressure inside the artery and arteriole each, to avoid the excesses that can lead to cardiovascular disease.

Capillaries to arterioles follow that release oxygen to the cells and recover their waste.

Then the blood, loaded with toxins from the cells, follows the path of return, using channels increasingly important: first venules and veins and venous trunks finally to eventual reach the vena cava (upper and below). These veins are very flexible and oval shaped. On the other hand, within their wall is not smooth, it is made of folds shaped nest of pigeons: the valves. These valves are designed to prevent blood from flowing back into the cells where it comes from.

Finally, venous blood enters the right heart. Then he left the high traffic for small circulation towards the lungs. Leaving the right heart, it happens in the arteries and arterioles and ends in the pulmonary capillaries. Once in the lungs, it discharges toxins that it has cleared the cells and oxygen due to the presence of air in the alveoli. It can then go back to the left heart, having grown from venous blood than in arterial blood. To return to its starting point, that is to say, the left heart, he borrows the pulmonary veins that do end up in the left atrium. From there, through the mitral valve, it enters the left ventricle and goes finally to the organs through the systemic circulation.

Usually the cause is right heart failure secondary to left heart failure. Note that the symptoms of left heart failure to be more visible that The right heart failure.

There is talk of heart failure or right ventricular failure secondary to (non exhaustive list):

Hypertension in the lungs (pulmonary hypertension) itself due to a lung infection such as chronic bronchitis with emphysema or pulmonary embolism (a blood clot presented in the pulmonary circulation)
Congenital heart disease (heart disease and congenital), such as communication between the two ventricles or between the two atria or a pulmonary stenosis

Asthenia (fatigue more or less)
Abdominal heaviness
Intestinal gas in large quantities
Nausea, vomiting
Of diarrhea

Pain in the right hypochondrium (right side of the abdomen) from a liver disease. These various digestive disorders sometimes occur spontaneously or after exercise.

In females, there is sometimes menstrual disorders (disturbance of rules), miscarriage or infertility.

The observation of the patient as a whole shows cyanosis (skin and mucous membranes grayish blue) or not associated with jaundice (jaundice).

Palpation of the jugular veins (each side of the neck) shows that they are clogged. The examiner shows a heat-jugular reflux when he presses the liver. This term refers to the increase in volume of the jugular vein compression due to progressive liver or abdomen. The jugular distension lasts as long as the compression issue. Pressures observed in the jugular vein are important and are a reflection of inadequate functioning of the right ventricle.

Abdominal palpation sometimes shows an increase of the liver that appears painful and smooth.

The patient presents with edema and sometimes spills. The resident edema in the lower limbs; it is a question of ankle edema (ankle) are eventually generalized; it is called hydrops. Regarding the pleura effusions, these are located either on one side or both sides (bilateral). There may also ascites. The acid is the accumulation of fluid in the peritoneal cavity (the peritoneum being the envelope which lines the inside of the abdominal cavity).

The cardiac auscultation depends on the origin of the disease. So when there is a rise in blood pressure within the lung's pulmonary second sound is louder. It is possible sometimes to hear what experts call early diastolic gallop (like a galloping horse). Often, there is also the presence of a systolic murmur (wind noise to the ejection of blood passing through the tricuspid valve to the right ventricle departure). This breath increases when the patient inhales (penetration of air into the lungs). Finally, in some cases, quite immediately, there are a very rapid acceleration atrial fibrillation type earphones.

The auscultation can hear signs of emphysema, wheezing (whistling) rattles, etc. .. It depends on the pathology (pneumonia caused chronic pulmonary heart disease, for example). Percussion and auscultation highlight changes usually normal sounds heard through the stethoscope (vesicular murmur: cavity filling is decreased; we also heard whistling due to chronic bronchitis). The use of an ultrasound stethoscope is considerably more interesting because more sensitive. In fact, thanks to its high specificity ultrasound stethoscope provide additional information and much more reliable. Unfortunately, the prohibitive price ($14 000) makes this instrument so far inaccessible less general medical practice.

Additional examinations and especially radiology can highlight chronic pulmonary, an enlargement of the ventricle from the right atrium, a widened mediastinum. The mediastinum is the region located in the chest between the lungs, in particular, contains the heart, great vessels (aorta, pulmonary artery, vena cava), trachea, bronchi, the largest, most part of the esophagus, lymph lymphatic vessels and nerves.

The electrocardiogram showed atrial fibrillation the atria (rapid heart beat and ineffective) quite frequently and specialists T-wave pulmonary high amplitude sharp and signs of increased right ventricular volume. When there is a left heart failure, there is also an increase in volume of the left ventricle associated or not with hypertrophy (increase in volume) of the right ventricle.

The ultrasound can distinguish between right heart failure and constrictive pericarditis.

Laboratory tests show the presence of proteinuria, cylinder granular sediment of urine. There is also an increase in the number of red blood cells, hematocrit and high creatinine slightly elevated.

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