Right ventricular failure Prepared by: Takabayev Maksat Sovetov Saken Parpieva Aliya Smagulova Gulnaz Checked by: Kelimbetova A.B.

Right-sided heart failure is defined as a process, not a disease, which often occurs due to left-sided heart failure, when the weakened and/or stiff left ventricle loses power to efficiently pump blood to the rest of the body. As a result, fluid is forced back through the lungs, weakening the hearts right side, causing right-sided heart failure. This backward flow backs up in the veins, causing fluid to swell in the legs, ankles, GI tract and liver. In other cases, certain lung diseases like COPD or pulmonary fibrosis can cause right-sided heart failure, despite the left-side of the heart functioning normally.

Right-sided heart failure signs and symptoms can range from mild to severe. A physician can determine if any of the following symptoms are being caused by right-sided heart failure: Awakening at night with shortness of breath Shortness of breath during exercise or when lying flat Coughing Wheezing Difficulty concentrating Dizziness Fatigue Fluid retention causing swelling in the ankles, legs, feet and/or abdomen Increased urge to urinate Lack of appetite and nausea Difficulty exercising Sudden weight gain

If any of these right-sided heart failure symptoms occur, call immediately. Dont self- diagnose; allow a medical professional determine if you are experiencing a life-threatening event. Sudden shortness of breath while experiencing a chest pain, a rapid or irregular heartbeat or fainting Coughing up white or pink phlegm while experiencing severe shortness of breath Severe weakness Fainting Rapid or irregular heartbeat Chest pain caused by a heart attack

To determine if a patient has right-sided heart failure, we use advanced technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures and technologies can include: Blood tests: These tests can measure substances that are elevated in people with heart failure, and check kidney, liver and thyroid function and look for signs of other diseases that affect the heart. Cardiac CT Scan: X-rays and computers are used to create images of the heart. This provides a more detailed picture than an ultrasound. Chest X-ray: A common imaging test to view the heart and lungs. The test can show whether the lungs Cardiac catheterization: A long, thin flexible tube is threaded through a blood vessel in the arm or groin and to the heart. Contrast material is injected through the tube and a type of X-ray movie is taken to show blockages in the heart. This procedure may be done along with a coronary angiography.

Coronary angiography: During the procedure, dye that can be seen on an X-ray is injected into the heart chambers or coronary arteries. The dye lets a physician study blood flow through the heart and blood vessels to detect any blockages. This procedure may be done along with a cardiac catheterization. Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the hearts chambers and valves. Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged or overworked. The hearts electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape. Myocardial biopsy: A long, thin flexible tube is threaded through a blood vessel in the arm, groin or neck and into the heart to remove a small piece of heart muscle. This heart tissue is studied under a microscope to determine whether heart disease is present that causes right- sided heart failure. Pulmonary functions studies: During these tests, you will breathe in and out of a tube that is connected to a measuring device. The device shows how well you can move air in and out of your lungs. Stress testing: This test is conducted during exercise to make the heart work hard and beat fast while heart tests are done. If a patient cant exercise, medicine is given to increase heart rate. Used along with an EKG, the test can show changes to the hearts rate, rhythm or electrical activity as well as blood pressure.

Graphic representation of echocardiographic parameters in the assessment of right ventricular failure. Ao, aorta; DTI, Doppler tissue imaging; EF, ejection fraction; ET, ejection time; FAC, fractional area change; IVC, inferior vena cava; IVCT, isovolumic contraction time; IVRT, isovolumic relaxation time; LA, left atrium; LV, left ventricle; LVEDD, left ventricular end-diastolic diameter; RA, right atrium; RIMP, rightventricular index of myocardial performance; RV, right ventricle/ventricular; RVEDD, right ventricular end-diastolic diameter; TAPSE, tricuspid annular plane systolic excursion; TR, tricuspid regurgitation.

Treatment for right-sided heart failure focuses on managing symptoms and treating underlying causes of the condition. An individualized plan of treatment may include medications, lifestyle changes, devices and/or surgery. Depending on the severity of the condition, treatment can include: Medication Medications are prescribed to improve cardiac function, treat symptoms like heart rate, high blood pressure and fluid buildup to: Reduce fluid retention and the loss of potassium Open narrowed blood vessels to improve blood flow Reduce blood pressure and slow a rapid heart rhythm Increase blood flow throughout the body and reduce swelling Reduce fluid by promoting urination Prevent blood clots Lower cholesterol Lifestyle Changes A few changes in lifestyle can improve the quality of life and symptoms. It is essential to follow a low-sodium, low-fat and low-cholesterol diet. Gentle aerobic exercise is also recommended. Surgery and Other Procedures If medications are not effective in managing right-sided heart failure, or if symptoms are severe, a ventricular-assist device implant or a heart transplant, may be necessary. Ventricular assist device (VAD) surgery: This device can be implanted to help a weak heart pump more efficiently. Heart transplant surgery: This surgery is done when all other right-sided heart failure treatments have failed. The damaged heart is surgically removed and replaced with a healthy heart from a deceased donor.

Acute RV failure is a complex clinical scenario and its appropriate management requires an understanding of RV anatomy and mechanics, rapid identification and treatment of underlying causes, and knowledge of supportive treatment measures. Many uncertainties remain, and there is a need for randomized trials to investigate the efficacy and safety of pharmacological and mechanical interventions for the treatment of acute RV failure.