RIGHT SIDED HEART FAILURE

References : Pathophysiology of Heart Disease 4 Edition Lilly Pubmed A.D.A.M 2011

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Definisi Ketidakmampuan Ventrikel kanan untuk mencukupi kebutuhan aliran darah ke sirkulasi pulmonal pada kondisi normal central venous pressure Etiologi Most common cause : presence of left sided heart failure Examples of Conditions that Cause Right Sided Heart Failure Cardiac Causes Left Sided Heart Failure Pulmonic Valve Stenosis Right Ventricular Infarction Parenchymal Pulmonary Disease COPD ( Chronic Obstructive Pulmonary Disease ) Interstitial Lung Disease ( ex : sarcoidosis ) Adult Respiratory Distress Syndrome Chronic Lung Infection / bronchiectasis Pulmonary Vascular Disease Pulmonary embolism Primary pulmonary hypertension

Pathophysiology LV Dysfunction

pulmonary vascular pressure

Transmisi ke RV

 Volume & Pressure RV ( dilatasi & hypertrophy )

Right Sided Heart Failure

Transmisi ke RA

Systemic Veins Congestion - Jugular Venous Distension - Peripheral Edema - Hepatosplenomegaly Treatment Causative ( treating left sided heart failure ) - Life style : asupan garam, berhenti merokok & alkohol, berat badan ( jika obese ) - Medications a. Diuretics ( retensi cairan ) Mild : Hydrochlorothiazide, chlorthalidone, and chlorothiazide Moderate severe : Furosemide, torsemide, or bumetanide Prevent salt retention & help severe heart failure Spironolactone b. Hearts workload ACE Inhibitor, ARBs, Hydralazine, Long-acting Nitrates c. Beta Blockers ( prevent death in HF ) Metoprolol, Carvedilol d. Digitalis ( heart muscle contraction ; prevent hospitalization ) - Implanted Devices CRT ( cardiac resynchronization therapy ) both ventricles contract at same time ICD ( Implanted cardioverter defibrillator ) Combined CRT ICD ( biventricular pacemaker ICD ) - Transplant severe HF tidak merespon berbagai terapi Complications - Arrhythmia - Fainting

COR PULMONALE Definisi Right sided heart failure akibat long term high blood pressure di pulmonary arteri & ventrikel kanan jantung Etiologi Most common cause : pulmonary hypertension Chronic lung condition : COPD, Chronic blood clots, Cystic fibrosis, interstitial lung disease ( scarring of lung tissue ), kyphoscoliosis, obstructive sleep apnea Lung problem is not a cause Idiopathic cor pulmonale Pathogenesis Pulmonary Hypertension

pulmonary vascular resistance

RV afterload ( prolonged )

Cor Pulmonale

Acute ( No RV Hypertrophy ) Clinical Manifestation -

Chronic ( RV Hypertrophy + Dilatation )

Dyspnea : work of breathing Tussive / effort-related syncope : inability RV to deliver adequate blood flow to Left sided heart Light-headedness Chest pain Lower extremity edema : RV filling pressure level CO2 Hypoxemia peripheral vasodilatation edema - Wheezing, coughing

Physical Findings
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Fluid build up in the belly area (abdomen) Abnormal heart sounds Bluish skin (cyanosis) Liver swelling Swelling (distension) of the neck veins, which is a sign of high right-heart pressures Ankle swelling

Lab Examination
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Blood test for brain natriuretic peptide (BNP) markers for cor pulmonale Chest x-ray pembesaran pulmonary arteri, hilar vessel, & descending right pulmonary arteri Echocardiogram RV thickness , pulmonary artery pressure Right heart catheterization confirm diagnosis pulmonary hypertension CT scan of the chest diagnosing acute thromboembolic disease Ventilation and perfusion scan of the lungs (V/Q scan) diagnosing chronic thromboembolic disease Blood antibody tests Lung biopsy (rarely performed) Measurement of blood oxygen by arterial blood gas (ABG) Pulmonary function tests

Treatment Tujuan : treat pulmonary hypertension ( causative ), control symptoms

- work of breathing

: noninvasive mechanical ventilation, bronchodilation - Pulmonary vasodilators : pulmonary pressure & RV Afterload a. Medika mentosa : Ambrisentan ( Letairis ), Bosentan ( Tracleer ), Calcium channel blocker, Diuretics, Prostacyclin, Sildenafil b. Other - Blood thinner resiko blood clot - Oxygen - Lung / heart-lung transplant medikasi gagal Complications Life threatening shortness of breath Severe fluid retention Shock Death