pulmonary hypertension | Dr Raghu

In our previous blogs, we’ve discussed the common symptoms and treatment options for heart failure. However, the plan of treatment depends on the side of the heart that’s affected.

Heart failure is usually of two types – left-sided and right-sided. While left-sided heart failure is the result of the weakening of the left ventricle, right-sided heart failure is caused due to a weak right ventricle.

right sided heart failure

In this article, we’ll take a closer look at right-sided heart failure to understand its causes and symptoms. Let’s get started.

What Is Right-Sided Heart Failure?

Right-sided heart failure is a condition characterized by the weakening of the heart’s right ventricle. That means the right ventricle can’t pump deoxygenated blood into the lungs with maximum efficiency. It results in a buildup of blood in the veins, thus causing swelling in the legs and abdomen.

What Causes Right-Sided Heart Failure?

The most likely cause of right-sided heart failure is a weak left ventricle. In other words, left-sided heart failure eventually leads to right-sided heart failure.

When the left ventricle becomes weak, it can’t pump an adequate amount of oxygen-rich blood into the body. It causes blood to back up into the lungs. That, in turn, means the right ventricle has to work harder to pump oxygen-depleted blood into the lungs. It results in the gradual weakening of the muscles and leads to right-sided heart failure. Left-sided heart failure is usually caused by coronary artery disease, hypertension, or a previous heart attack.

Additionally, any condition that taxes the right ventricle’s pumping power can lead to right-sided heart failure. These include:

What Are the Symptoms of Right-Sided Heart Failure?

One of the most common right-sided heart failure symptoms is swelling in the legs and abdomen due to fluid buildup. Accumulation of fluid in the abdomen can also cause nausea, bloating, and loss of appetite.

Other symptoms of right-sided heart failure include:

How Is Right-Sided Heart Failure Diagnosed?

Firstly, a cardiologist will ask you about your symptoms and medical history. Also, they’ll perform a physical examination to check your blood pressure and heart rate. They might even use a stethoscope to identify abnormal heart sounds.

They can also recommend routine blood tests, such as complete blood count, lipid panel, and electrolyte tests. Additionally, they can order a brain natriuretic peptide test.

Besides blood tests, doctors also order the following lab tests to diagnose right-sided heart failure:

Right-Sided Heart Failure vs. Congestive Heart Failure

Congestive heart failure is an outdated term that was used to refer to fluid buildup in the lungs due to a weak left ventricle. However, a more inclusive term – heart failure – is used now. Right-sided heart failure is a specific type of heart failure caused by a weak right ventricle.

Final Thoughts

The most common right-sided heart failure symptoms include swelling in the legs and abdomen, breathlessness, and chest pain. Doctors use a variety of tests, including ECG, coronary angiography, and chest X-ray, to diagnose the condition and determine the right course of treatment.

Dr. C Raghu is an eminent cardiologist specializing in interventional cardiology. He’s helped several patients with serious heart conditions. If you or someone you know is experiencing symptoms of heart failure, reach out to Dr. Raghu today.

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      An atrial septum is a muscular wall that separates the upper chambers of the heart called atria. An ASD is a common congenital heart disease where the septum is not formed properly producing a left-to-right shunt, which leads to mixing of oxygenated and deoxygenated blood. This causes pulmonary hypertension and right heart enlargement.

      What are the treatment options for ASD?

      Small atrial defects do not need any treatment and close on its own. Even in adulthood small ASDs may remain asymptomatic. Some large defects that persists in adulthood may become symptomatic and need closure. The ASDs can be closed by:

      • Percutaneous closure using a device
      • Closure through open heart surgery

      Percutaneous device closure is the preferred treatment for certain defects type.

      What is Percutaneous Closure of Atrial Septal Defect (ASD)?

      A noninvasive procedure known as percutaneous transcatheter approach is considered depending on the size and severity of the defect. Moderate to large-sized ASD along with pulmonary hypertension requires to be closed. The procedure is performed by inserting a special closure device either folded or attached to a catheter into the vein of the leg and is advanced to the heart through the defect, which closes the hole by a special mechanism.

      Are there risks associated with the procedure?

      The success rate of the procedure is about 95%. But the risks involved, and their estimated incidence of occurrence include:

      • Device dislodgement leading to emergency heart surgery: 1%
      • Device erosion (device eroding through the heart walls): 0.3%
      • Death: less than 1% usually due to perforation of the heart chamber
      • Dislodgement of clot or air bubbles to the brain leading to other organs: less than 1%
      • Arrhythmia: 1 to 2%
      • Allergic dye reaction
      • Anaesthetic reaction
      • Injury to the artery/vein/nerves in the groin
      • Perforation of the oesophagus
      • Infection
      • Allergic reaction to the nickel component of the device

      Patients with small ASD may not develop any complications, but large-sized defects may lead to serious complications which demands surgery and prolonged hospitalization.

      What is the pre-procedure work-up?

      Pre-operative tests to assess the general health of the patient include:

      • Chest x-ray
      • Electrocardiogram
      • Blood tests
      • Kidney function

      A detailed diagnosis of the defect should be performed which includes transthoracic and transoesophageal echocardiogram used to assess the size, location and the suitability of the procedure.

      How should I prepare for the procedure?

      • Patients wearing dentures, glasses or a hearing assist device can plan to wear them during the procedure.
      • Patient will be instructed about dietary restriction to be followed before the procedure.

      Are there any specific instructions about medications?

      • The healthcare provider may ask you to stop certain medications, such as warfarin or other blood thinners.
      • If diabetic, consult the physician about how the medication needs to be adjusted.
      • Provide information about specific allergies regarding iodine, shellfish, X-ray dye, latex or rubber products etc.

      What happens during the procedure?

      • The patient might be asked to have a shower before the procedure.
      • The patient is asked to wear a hospital gown and lie on an X-ray table where an X-ray camera will move over the chest during the procedure.
      • Arrangements for intravenous administration of medications or fluids during the procedure will be made.
      • The site where the catheter will be inserted is cleaned and sterile drapes were used to cover the site to prevent the infection.
      • Electrodes will be placed on the chest and are attached to an electrocardiograph monitor (ECG).
      • A sedative might be given to relax, and a local anesthetic is given to numb the site of catheter introduction.
      • A plastic sheath will be inserted in the groin, through which a catheter is inserted and threaded to the heart.
      • The physician may also inject a dye which may make you feel hot or flushed for several seconds. Inform the doctor if there is an allergic reaction like itching or tightness in throat, nausea and chest discomfort.
      • The X-ray cameras are used to obtain the measurements of pressures and oxygen content in the chambers.
      • The appropriate size and the location of the closure might be visualized using a small catheter connected with an ultrasound transducer.
      • A special catheter is used to advance the device into the heart and through the defect.
      • The device is slowly pushed out of the catheter allowing each side of the device to open and close each side of the hole in the septum.
      • The proper position of the device is ensured and is released from the catheter.
      • It may take 1-2 hours for the procedure, but preparations must be made to spend about 5-9 hours in the hospital.
      • The patient should be accompanied by someone who can drive him home, as the patient will not be allowed to drive on the same day.

      What care should be taken after the procedure?

      • The catheter and the imaging probe are removed after the completion of the procedure.
      • Pressure on the incision site or occasionally a small suture is used to close the vein.
      • Bed rest is advised for several hours to prevent bleeding, but call the doctor if you notice any bleeding.
      • You might be advised to drink plenty of water to wash out the contrast material from the body.
      • Your heart rate and rhythm are monitored; you may be asked to stay overnight in the hospital.
      • Medications, such as aspirin are prescribed to prevent blood clots.
      • Strenuous activity and heavy lifting should be avoided for at least six months.
      • Antibiotic prophylaxis is required for at least six months or lifelong to prevent endocarditis, as per doctor’s advice.

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