LP Heart Failure Discussion Paper

Introduction

Your discussion on heart failure was very insightful given the manner in which you broke down the pathophysiological differences between left LHF and right heart failure RHF (Krüger, 2017). This response will therefore refine the risk factors and treatment differences involved in each type.

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Risk Factors

In LHF you were accurate to mention ischemic heart disease, hypertension and diabetes as of one of the important causes. These conditions mainly involve the left ventricle through augmentation of afterload and preload with resultant low cardiac output and pulmonary edema (Ghio, 2021)LP Heart Failure Discussion Paper. Right heart failure (RHF) is less common than left heart failure, and most often its cause is left heart failure, but can also be caused by certain pulmonary diseases like COPD, cystic fibrosis or pulmonary hypertension. These problems with the lungs raise the right ventricle’s workload and the heart may fail if the right ventricle does not adapt. The NO in RHF includes signs of systemic venous congestion that are different from the pulmonary signs of LHF such as dyspnea.

Treatment

Of course, LHF, and especially systolic, is usually managed with diuretics and, ACE inhibitors and beta blockers. These medications are made to lessen the overaccumulation of fluids, interfere with the functioning of RAAS, and lessen the load on one’s heart (Marín-García, 2010)LP Heart Failure Discussion Paper. There is need to prescribe diuretic for conditions of fluid overload and ACE inhibitors and beta-blockers for neuroendocrine activation. On the other hand, management of RHF entails managing the contributing pulmonary diseases such as increasing oxygen therapy in chronic obstructive pulmonary disease or managing Pulmonary arterial hypertension. Diuretics may also be used for SVCO but the treatment isa directed more towards the pulmonary manifestations which are the main cause of RHF.

Conclusion

To summarize, left heart failure, right heart failure has symptoms that are similar in the advanced stages that both chambers are affected; nevertheless, risk factors and therapies are different. Left-sided failure mainly arises from systemic cardiovascular diseases, while RHF often results from pulmonary diseases or represents an acquired complication of left heart failure.

References

Ghio, S. (2021). Left-heart failure and its effects on the right heart. The Right Heart, 157-162. https://doi.org/10.1007/978-3-030-78255-9_10

Krüger, W. (2017). Acute right heart failure. Acute Heart Failure, 209-271. https://doi.org/10.1007/978-3-319-54973-6_4

Marín-García, J. (2010). Treatment of acute heart failure. Heart Failure, 6, 379-392. https://doi.org/10.1007/978-1-60761-147-9_20 LP Heart Failure Discussion Paper

LP Heart Failure discussion

Heart failure happens when the heart is unable to generate an adequate cardiac output (CO), causing inadequate tissue perfusion, or when there is an increased diastolic filing pressure of the left ventricle, or both, so the pulmonary capillary pressures increase (Rogers, 2023). Most of these causes are usually from the failure of the left ventricle. The biggest risk factors are ischemic heart disease, diabetes, and hypertension. All of these disease significantly increase the workload of the heart. When the heart is overworked with either pre-load or after-load it begins to fail. According to Rogers, heart failure is responsible for 800,000 hospital admissions and 83,000 deaths per year in the United States. “More than 2 decades after it’s designation as an emerging epidemic, HF remains a clinical and public health problem of major proportion” (Roger,2021)LP Heart Failure Discussion Paper.

Left heart failure (Congestive Heart Failure), is the type of heart failure with reduced ejection fraction (EF) (systolic heart failure) or heart failure with preserved EF (Diastolic Heart Failure) (Rogers, 2023). In systolic heart failure, there is an  increased preload, decreased contractility, or increased after load. This increases pulmonary venous pressure and pulmonary edema from the back up. “Patients with left heart failure may present with complaints of shortness of breath (often on exertion, a sensitivity of 89%), orthopnea (a specificity of 89%), paroxysmal nocturnal dyspnea and/or symptoms of volume overload (e.g., leg swelling, weight gain, increased abdominal girth, or right upper quadrant pain due to liver congestion)” (Chahine & Alvey, 2023). There becomes a neuroendocrine response to this failure. This makes this condition worse and triggers the renin-angiotensin-aldosterone system (Rogers, 2023). Activating this could cause fluid retention, increased contractility, and elevate the heart rate. It then, becomes necessary to treat this with diuretics, ACE inhibitors, and beta-blockers. All of these medications have different jobs in stopping certain points of this renin-angiotensin- aldosterone system and reducing the workload of the heart. Diastolic heart failure is heart failure with preserved ejection fraction. This is characterized by signs and symptoms of heart failure, a preserved ejection fraction, and improper diastolic function (Rogers, 2023)LP Heart Failure Discussion Paper. This means that the left ventricular end-diastolic is increased. Even when cardiac output is normal the pressure continues to be increased.

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Right heart failure the right ventricle isn’t about to put out enough output to provide adequate blood flow to the pulmonary circulation (Rogers,2023). Sometimes with left heart failure and it’s inadequacy to pump what it needs to into the right side of the heart it can lead to right sided heart failure. “Clinically, patients present with the signs and symptoms of hypoxemia and systemic venous congestion” (Mandras and Desai, 2023). Pulmonary disease can also be a contributing factor to right sided heart failure. When the right side fails it’s usually because the left side fails. If the left side didn’t fail it could be related to pulmonary disease such as cystic fibrosis, COPD, and acute respiratory distress syndrome. All of these disorders increase after load. Cardiac conditions can also interfere with right ventricular contractility ending up with right side failure. “Traditional cardiovascular risk factors often coexist and can interact with one another to increase the likelihood of developing HF” (Roger,2021)LP Heart Failure Discussion Paper