-: RIGHT HEART FAILURE :-

Right heart failure

Most of the cases of RHF is caused
by LVF

Whenever there is LVF if it is

prolonged duration it will
eventually lead to pulmonary
hypertension that may result into
RVF
CAUSES OF RVF :-
1) Secondary to LVF
2) RVF may be due to pulmonary hypertension to some primary
disease of lungs
COR PULMONALE:- Right ventricular hypertrophy,
dilatation and eventually failure due to pulmonary hypertension
which is not due to LVF
3) Pulmonary valve stenosis :- causing pressure overload on
right ventricle
4) Pulmonary valve regurgitation :- producing volume
overload
Whatever the cause of failure of RV what really happens is:-
Pressure in the RV goes up
So it becomes difficulty to empty from RA to RV
Hence pressure in RA goes up
So venacaval system cannot drain into right atrium
JVP pressure goes up so this is one of the very early feature of
RVF
SO WHEN RV IS FAILING IT BACKFIRES INTO SYSTEMIC
CIRCULATION AND PORTAL CIRCULATION.
BUT WHEN LV WAS FAILING IT BACKFIRES INTO
PULMONARY

MORPHOLOGY :-
1) ON HEART :-
Tricuspid or pulmonary valve abnormalities or endocardial fibrosis
may be present
Hypertrophy and dilatation of RA and RV may be present
2)LIVER AND PORTAL SYSTEM:-
Congestion of the hepatic and portal vessels may produce
pathological changes in liver
Liver increases in size and weight due to passive congestion
And it will be greatest around the central vein
It leads to red brown colour with relatively normal coloured tan
periportal areas which is characteristic of NUTMEG LIVER
Congestive hepatomegaly is seen
3) CONGESTIVE SPLEENOMEGALY:-
It is due to portal venous hypertension
4) CONGESTION AND EDEMA OF BOWEL WALLS
5) Fluid gets accumulated in pleural, pericardial, and
peritoneal spaces causing pleural, pericardial, peritoneal
effusions
Large pleural effusions cause lung atelactasis
6) ASCITES
7) Fluid gets accumulating in subcutaneous tissues causing
edema of peripheral and dependent portions of the body
TREATMENT OF CHF :-
Pharmacological drugs are given to relieve fluid overdose ( eg :-
DIURETICS)
Block renin angiotensin axis ( eg :- ACE INHIBITORS)
Increase myocardial contractility by positive ionotropes
Lower adrenergic tone ( eg :- beta 1 adrenergic blocker )
NEWER APPROACH :-
Mechanical assist devices
Cardiac resynchronization therapy :- exogenous pacing of both
the right and left ventricles to maximise cardiac efficiency
Cell based approaches
THANK YOU