Right-sided heart failure. Right ventricular failure is a problem to diagnose and to treat correctly. 7
Right heart failure can manifest with shortness of breath and ankle swelling. Heart MRI can help to diagnose right heart failure. Leading heart and lung disease expert. What is a Right-sided heart failure? Dr. Anton Titov, MD. Why Right-sided heart failure attracted less attention previously? Dr. Anton Titov, MD. It is a cause of heart failure that is very important to determine. How to find appropriate treatment for right ventricular heart failure? Dr. Anton Titov, MD. Dr. Aaron Waxman, MD. Right ventricular heart failure is a continuum of dysfunction of the right ventricle. We think the Right-sided ventricle is part of the right-sided heart system. It includes the pulmonary vascular network, both the pre-capillary and post-capillary pulmonary vascular network. Right-sided heart system also includes the right atrium and the systemic veins draining into the right heart. Dr. Aaron Waxman, MD. The most common cause of Right-sided heart failure is left-sided heart failure. Pressures rise in the left heart. Pressure backfills into the lung and ultimately affect the Right-sided heart. We focus on the pulmonary vascular diseases. Dr. Aaron Waxman, MD. The primary dysfunction is in the blood vessels of the lung. Such as pulmonary arterial hypertension. Lung blood vessels become stiffer and more rigid. That causes a back fill of pressure and volume into the right heart. The right heart ventricle is a muscle. But it is much more complex muscle than the left heart. Because right ventricle of the heart has a U-shape to its inflow-outflow tract. Right ventricle changes its contractility from the beginning of heart muscle contraction. Right ventricle also has a much lower pressure. It has a lower resistance-high compliance system. Dr. Aaron Waxman, MD. In disease, compliance of heart muscle starts to decrease and resistance starts to increase. Then the muscle is at a disadvantage. Right ventricle starts to dilate. It starts to undergo fibrosis. Right ventricle becomes less effective for contraction. The Right-sided heart contracts in a much more of a peristaltic contraction. It contracts in a down-stream wave. Right ventricle contraction follows this U-shape. Right-sided heart muscle is at a disadvantage structurally relative to the left side of the heart. Patients have Right-sided ventricular dysfunction, they ultimately develop heart failure. These patients will develop shortness of breath. Then patients will start to accumulate fluid. Dr. Aaron Waxman, MD. They may get lower extremity edema first. Or patients may collect fluid in their abdomen. They could have even have frank ascites. With time goes, right ventricular heart failure gets worse and worse. Dr. Anton Titov, MD. You do cardiac echocardiography for patients with right ventricular failure. What additional invasive diagnostic testing do you do in patients with right ventricular heart failure? Dr. Anton Titov, MD. Is more specific treatment available for right ventricular heart failure? Dr. Anton Titov, MD. Yes, we do cardiac imaging. Echocardiography is certainly an easy way to look at the heart. Although heart ultrasound is not necessarily. Because you just can’t see all of right-sided heart muscle. Dr. Aaron Waxman, MD. The best way to look at the Right-sided heart is Cardiac MRI. Heart MRI is becoming very important in how we assess right ventricular structure and function. We do Right-sided heart catheterization to get pressure assessments. We do even a cardiac CT sometimes. But mostly we perform cardiac MRI for patients with suspected rich-sided heart failure and shortness of breath. Dr. Aaron Waxman, MD. There is no specific treatment for right ventricular heart failure. We target the pulmonary vascular network. We do use some of the heart-stimulating medications that we use for left heart failure. But they are probably much less effective for pure right-sided heart failure than they are for the left heart failure. This is one of the real challenges now. We must find targeted therapy for the right ventricular heart failure.
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