right heart failure
What is right heart failure?
Right heart failure is a subtype of heart failure. Heart failure refers to a malfunction or weakness of the heart. This is no longer able to perform its tasks correctly. It can not pump enough blood into the body to adequately circulate all organs.
The circulation is also attacked and weakened. Right heart failure affects only the right half of the heart or the pumping power of the right ventricle. The right half of the heart has the task to pass the oxygen-poor blood into the lungs, so that it can be enriched there with new oxygen. But if there is a right heart failure, backflow of the blood occurs back into the body veins. As a result, the venous pressure increases, which increases the accumulation of water in the tissue.
The most common cause of right heart failure is chronic left ventricular failure. Because this leads to a backwater of the blood into the pulmonary vessels. An increased pressure in the lungs is then the result.
To compensate, the right half of the heart needs to use more force to pump the blood into the lungs. Overloading makes the muscle layer in the right ventricular wall thicker and thicker. In the further course, the right half of the heart also fails because the overload becomes too great.
Other causes for the development of right heart failure are diseases of the lung such as pulmonary hypertension, ie a pathological increase in blood pressure in the pulmonary circulation. A heart valve defect, which may manifest itself, for example, in the reduction of blood flow from the right ventricle of the heart, is a possible cause.
Symptoms, complaints & signs
In right heart failure, backflow of blood occurs in front of the right heart. This backwater causes edema in the body, which occurs mainly on the lower legs and ankles. First of all, these edemas are especially noticeable at night when the heart is relieved. Chronic right heart failure can also lead to nocturnal urination (nocturia).
In some cases there is an accumulation of fluid in the abdominal cavity (ascites), which can lead to respiratory problems. Symptomatic of a right ventricular failure may also be a jugular vein congestion, recognizable by a volume overflow of the jugular veins. The backflow of the blood can lead to the disturbance of individual organ and body functions.
Here are the liver, kidneys, spleen or the gastrointestinal tract affected, recognizable by constipation, loss of appetite, food intolerances. In most cases, right heart failure is preceded by chronic respiratory disease or pulmonary embolism, that is, the occlusion of one or more pulmonary arteries, which also causes symptoms such as difficulty in breathing, shortness of breath, shortness of breath, and blue discoloration of the skin.
Also symptomatic of chronic right heart failure are: fatigue and decreased performance. Cardiac shock, shortness of breath (dyspnoea), increased heart rate (tachycardia), and cyanosis, a blue coloration of the skin, are associated with acute right heart failure.
Diagnosis & History
To diagnose a right heart failure echocardiography and an x-ray thorax are usually made. In echocardiography, the heart is displayed using ultrasound. By analyzing both x-ray and ultrasound images, a cardiologist can quickly detect right heart failure by enlarging the right half of the heart.
The course of the disease in a right heart failure is insidious, because it creates the heart relatively long to compensate for malfunctions and thus make symptoms relatively late noticeable. The first noticeable symptoms are diminished physical performance, such as during sports, as well as frequent tiredness and listlessness.
In the further course it can come then to increased air emergency. The development of edema can also cause swelling of legs and feet. In the worst case, the heart can completely refuse its service and cause a heart attack.
Right heart failure can have several serious consequences. If she expands to an acute decompensated heart failure, even life-threatening consequences threaten. Typical symptoms of right heart failure include edema (accumulation of water), which primarily affects the lower legs and the back of the foot. They usually go along with an increase in weight.
In the night hours, it comes to the reduction of water retention from the body. For this reason, the patient has to interrupt his sleep several times to go to the bathroom, which in turn causes sleep disturbances. If an accumulation of blood also occurs on organs such as spleen and liver, they gain in size. Sometimes it develops painful pressure on the abdomen and it forms at this point tissue water, what doctors call ascites (ascites).
Right heart failure can also trigger a variety of sequelae that make it even worse. Among other things, this affects the respiratory system, in which a pulmonary edema forms or a congestive bronchitis occurs, which is noticeable in permanent cough.
Another possible effect of heart failure is the significant decrease in weight that occurs in a chronic form. The sufferers often suffer from underweight. The most serious complication of right heart failure is sudden cardiac death. The risk increases with the severity of heart failure. Other sequelae include cardiac arrhythmia, thyroid disease, anemia, sleep apnea or pneumonia.
When should you go to the doctor?
Right heart failure must always be examined and treated by a physician. In the worst case, it can lead to the death of the person affected or greatly reduce the life expectancy of the patient. The further course depends on when the right heart failure is recognized and treated. The earlier the diagnosis and treatment are initiated, the higher the likelihood of a positive course of the disease. The doctor should be consulted if the person suffering from frequent nocturnal urination.
Restrictions and complaints in breathing may also indicate right heart failure and should always be examined by a physician. Patients often suffer from severe tiredness or various digestive problems. If these symptoms are prolonged and do not disappear again, a medical examination is necessary in any case. Right heart failure can be diagnosed by a cardiologist. However, in some cases, surgery may require surgery. The right-sided heart failure may also limit the life expectancy of the person affected.
Treatment & Therapy
The treatment of right heart failure depends primarily on the severity of the disease. At the first signs of right heart failure, it may be sufficient to adjust the circumstances of the disease.
Smoking and drinking should then be restricted or stopped altogether, normal body weight aimed at and stress avoided. More advanced stages of heart failure can be treated with medications. These are intended to prevent possible complications and to combat the symptoms of the disease. Diuretics, for example, have a diuretic effect and relieve the heart and the vessels in which water has been stored.
In addition, ]] beta-blockers]], which prevent cardiac arrhythmias, and ACE inhibitors, which dilate the blood vessels and thus relieve the heart, are often used. In more serious cases, however, implantation of a pacemaker or implantable defibrillator is needed. These can react to or prevent severe cardiac arrhythmias.
If, despite all these methods, heart failure continues to worsen, in some cases, only a heart transplant can help. In this case, the person affected either a donor heart or an artificial heart is used. However, since such a transplantation carries enormously high risks, such as a rejection reaction on the part of the body, it is only considered in absolute emergency.
The best way to prevent Right Heart Failure is to have a healthy and conscious lifestyle. The absence of nicotine and the moderate consumption of alcohol promote the health of the heart as well as a balanced, low-salt diet. Also, a lot of exercise in the fresh air, sports and the avoidance of too much stress in everyday life and at work can prevent a Rechtsherzinsuffizienz.
Although heart failure today is very treatable due to improved medical options and the quality of life of sufferers has risen sharply, it remains one of the most common types of death and should not be underestimated. As they develop creepingly, especially older people should regularly have a check-up with a cardiologist.
In right-sided heart failure, symptomatic follow-up takes place in order to reduce the risk as far as possible. A drug treatment of the cause is appropriate. If it is in hypertension, antihypertensive drugs are prescribed. Furthermore, medicines are used to increase the pumping power of the heart and diuretics to reduce the heart burden.
Advanced right heart failure requires the use of a pacemaker with an integrated defibrillator or a biventricular pacemaker. These help to balance the heart failure and to avoid cardiac arrhythmia. If the heart is severely damaged, a heart transplant or a bypass may be necessary.
After the illness a healthy lifestyle should be led. Light physical activities and a healthy diet are important here. Other approaches should include giving up nicotine and alcohol and avoiding obesity. Excessive fluid intake should be avoided and the correct amount should be discussed with the physician.
Check-ups at regular intervals with the specialist are important. These focus on checking heart failure and adjusting medication if necessary. Also, as a precaution, vaccinations against influenza and pneumococci should be performed. The prognosis in right heart failure depends on the phase of insufficiency. It is important to adhere to the prescribed therapy to avoid complications or worsening. Heart failure leads to death in many cases.
You can do that yourself
The treatment of right heart failure depends on the severity of the disease. Especially in mild cases, the most elderly patients can do a great deal to prevent a chronic course with the dreaded complications such as arrhythmia, pneumonia, sleep apnea or cardiac death.
Anything that unnecessarily strains the heart is taboo: this includes nicotine and alcohol, but also overweight. If you are overweight, it is therefore recommended to lose weight. It makes sense here to change the diet slowly, because even a rigorous diet strains the heart. In addition, studies have shown that diet changes in contrast to crash diets show long-term success. Since patients with right heart failure tend to store water, the diet should be as low in salt as possible.
Even though those affected are physically less resilient, they can still move around in the open air regularly. Walking, walking or even hiking and cycling are sensible sports activities.
The affected patients should avoid stress, as it also harms the heart. There are several ways to reduce stress and move towards a more optimistic worldview. This can be done through psychotherapy, but also through gentle sports such as Reiki and Yoga, meditation and breathing exercises, or Progressive Muscle Relaxation according to Jacobson. Regular rest and bedtime additionally promote relaxation.