About-Cardio
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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Right Heart Failure Treatment
Introduction
Right heart failure (RHF) occurs when the right ventricle (RV) fails to pump blood efficiently into the pulmonary circulation, leading to systemic congestion. It can result from left heart failure, pulmonary hypertension, or intrinsic right ventricular dysfunction. Prompt and appropriate management is crucial to improving outcomes.
Causes of Right Heart Failure
- Left-sided heart failure (leading to increased pulmonary pressure and RV overload)
- Pulmonary hypertension (high blood pressure in lung vessels)
- Chronic lung diseases (such as COPD or interstitial lung disease)
- Right ventricular myocardial infarction
- Congenital heart disease (e.g., atrial septal defect)
- Pulmonary embolism (blockage of pulmonary arteries)
Symptoms of Right Heart Failure
- Peripheral edema (swelling in legs and feet)
- Jugular venous distension (JVD)
- Ascites (fluid accumulation in the abdomen)
- Hepatomegaly (enlarged liver, causing discomfort in the upper right abdomen)
- Fatigue and weakness
- Difficulty breathing, especially when lying down
Diagnosis and Evaluation
- Clinical assessment (physical examination and history)
- Echocardiography (to assess RV function and pulmonary pressure)
- Cardiac MRI (for structural evaluation)
- Blood tests (BNP/NT-proBNP, liver function tests)
- Right heart catheterization (gold standard for measuring pulmonary pressures)
- Electrocardiogram (ECG) (to look for arrhythmias and signs of RV strain)
Treatment Strategies
1. Treat Underlying Causes
- Manage left heart failure (using guideline-directed therapy)
- Control pulmonary hypertension (with specific pulmonary vasodilators)
- Address lung diseases (oxygen therapy, bronchodilators in COPD, etc.)
- Treat pulmonary embolism (anticoagulation, thrombolysis if severe)
2. Optimize Right Ventricular Function
- Diuretics (e.g., furosemide, torsemide) to reduce fluid overload
- Aldosterone antagonists (e.g., spironolactone) to manage volume status
- Pulmonary vasodilators (e.g., sildenafil, bosentan) in pulmonary arterial hypertension cases
- Inotropic agents (e.g., dobutamine, milrinone) in cases of severe decompensation
3. Supportive Measures
- Maintain optimal oxygen levels (supplemental oxygen if needed)
- Sodium and fluid restriction to prevent volume overload
- Regular monitoring (follow-up echocardiograms and biomarker tests)
- Heart transplant or mechanical circulatory support (in end-stage cases)
Conclusion
Right heart failure requires comprehensive management, addressing both the underlying cause and symptomatic relief. Close coordination with cardiologists and pulmonologists is often necessary for optimal treatment outcomes.
Source recommendations
1. American College of Cardiology/American Heart Association Guidelines for the Management of Heart Failure
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
- https://www.acc.org/Guidelines
- https://www.jacc.org/doi/10.1016/j.jacc.2023.12.024
- https://www.acc.org/education-and-meetings/products-and-resources/features/global-cv-institute/heart-failure-guidelines
- https://professional.heart.org/en/science-news/-/media/832EA0F4E73948848612F228F7FA2D35.ashx
2. European Society of Cardiology Guidelines for Acute and Chronic Heart Failure
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
- https://academic.oup.com/eurheartj/article/42/36/3599/6358045
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines
- https://pubmed.ncbi.nlm.nih.gov/34447992/
- https://academic.oup.com/eurheartj/article/44/37/3627/7246292
3. European Respiratory Society Guidelines on Pulmonary Hypertension
- https://publications.ersnet.org/content/erj/early/2022/08/25/1399300300879-2022
- https://academic.oup.com/eurheartj/article/43/38/3618/6673929
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pulmonary-Hypertension-Guidelines-on-Diagnosis-and-Treatment-of
- https://pubmed.ncbi.nlm.nih.gov/36017548/
- https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/08/30/19/11/2022-ESC-Guidelines-for-Pulmonary-Hypertension-ESC-2022
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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Every 3-5 years, half of the scientific approaches to treatment in the field of cardiology are reviewed as a result of specialized scientific discoveries. With us, you don't have to wait these years to learn about the best ways to treat you and your loved ones.