LECTURE: HEART DISORDERS WEEK: 1 CHF-RIGHT- SIDED HEART FAILURE (RHF) Heart Failure that affects the right side of the heart CAUSES CLINICAL FEATURES Left-sided heart Failure (LHF) Cor pulmonale Lung diseases COPD Right heart failure Congestion of peripheral tissues Decreased cardiac output Increased jugular venous pressure (JVP) Enlarged liver (hepatomegaly) Heart affected disorders Dependent edema and ascites Liver congestion GI tract congostion Signs related to impaired liver function Anorexia, GI distress, weight loss Activity intolerance and signs of decreased tissue perfusion Ascites (peritoneal effusion) Oedema of legs and ankles Disordered/reduced eating (anorexia) CLINICAL MANIFESTATIONS When the right side of the heart Fails it is unable to pump blood out of the right ventricle which causes pooling into the right atrium, superior and inferior vena cava's. Backwards Effect Head and arms CO2 Jugular vein (also subclavian vein from arms) 02 Carotid artery (also subclavian artery to arms) As a result blood backs up into the venous system causing an excess amount of blood throughout the body through the venous system. This causes an increased amount of blood in the liver, spleen, abdomen and trunk which can spread to and cause effusion in the the peritoneal, pleural & pericardial space due to the increased hydrostatic pressure causing Fluid to leave the blood vessel. Forewards Effect Pulmonary artery Lungs Aorta Superior vena cava CO2 02 Inferior vena cava Hepatic vein- Heart Hepatic portal vein Liver Digestive tract Pulmonary vein Mesenteric arteries Limited blood Flow to the pulmonary artery restricts blood going to the lungs reducing the amount of blood pumped to the left side of the heart causing low cardiac output to the rest of the body. This causes reduced renal perfusion, activating RAAS Further elevating BP, although there was no bp drop, Further worsening the situation in the right side of the heart . Renal vein Renal artery Kidneys Iliac artery CO2 O2 Trunk and legs Figure 2: Circulation of blood