| ID | 81 |
|---|---|
| Name | RIGHT HEART FAILURE |
| Cause | Causes: 1. Mitral stenosis- commonest cause. 2. Secondary to L.V.F. 3. Cor-pulmonale due to- a. chronic bronchitis, b. emphysema. 4. Pallets tetralogy. 5. Left to right shunt e.g ASD, or VSD. 6. Pulmonary embolism. 7. Cardiomyopathy & sereve anemia. |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigations: 1. X-ray chest- Biventricular hypertrophy or only right ventricular hypertrophy depending on cause. 2. E.C.G- Right ventricular hypertrophy with right axis deviation or biventricular hypertrophy may be present. 3. Echocardiograpy |
| Management | Management: 1. Rest in bed in propped up position. 2. Oxygen inhalation. 3. Diuretics- Frusemide may be given with potassium supplement- see above as in left heart failure. 4. Digitalisation- Digitalis is used in selective cases, e.g atrial fibrillation & atrial flutter. 5. Treatment of precipitating disease, i.e chronic bronchitis with emphysema, pulmonary infarction, anemia, myocardial infarction and onset of arrhythmia. 6. Advice- a. Salt restricted diet. b. Avoide heavy physical work. c. Frusemide 40mg twice weekly with potassium supplement if required. d. If sputum is yellowish & excessive- give an appropriate antibiotic. e. Advice to attend a physician every 2 months interval. |
| Introduction | It is a condition characterised by in ability of the right ventricle to propel blood forwards resulting in engorgement of right atrium, systemic veins with enlargement of liver & dependent oedema. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: Symptoms- 1. Dyspnoea & cough. 2. Weakness, tiredness & anorexia. 3. Swelling of feet & abdomen. 4 Right upper abdominal discomfort due to tight capsule of swollen liver. 5. Oliguria at day & polyuria at night. 6. Mental confusion in server cases. Signs- 1. Dependent oedema, e.g. oedema of leg due to venous congestion. 2. Cold hand due to reduced peripheral blood flow. 3. Venous pressure high, e.g., engorged neck vein, ascites. 4. Small volume pulse. 5. Sinus tachycardia may be present in severe cases. 6. Hepato-jugular reflux present. 7. Liver enlarged & tender. 8. Lung usually clear. 9. Splenomegally in prolonged congestion of liver. 10. On examination of heart- a. Evidence of causes- e.g pansystolic blowing; coarse or harsh systolic murmur of bicuspid insufficiency, usually increased intensity during and just after inspiration, b. Gallop rhythm may be present. |
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