Right-Sided Heart

Failure

By:

Jennine Marleen G. Reyes

Emergency Room

Group IA
I. Introduction

Congestive heart failure is a condition wherein the heart is unable to pump the amount of
oxygenated blood necessary to effect venous return and to meet the metabolic requirements of the
body. This can happen when the heart muscle is weaker than normal or when there is a defect in the
heart that prevents blood from getting out into the circulation. When the heart does not circulate
blood normally, the kidneys receive less blood and filter less fluid out of the circulation into the urine.
The extra fluid in the circulation builds up in the lungs, liver, around the eyes, and sometimes in the
legs. This is called fluid ‘congestion’ and for this reason doctors call this “congestive heart failure”.

Causes of Congestive Heart Failure:

 Direct damage to the heart (e.g. mitral myocarditis, ventricular aneurysm)

 Ventricular overload

o Increased preload (e. g. mitral or aortic regurgitation, atrial or ventricular septal

defects, or rapid infusion of large volumes of IV fluids)

o Increased afterload (e.g. aortic or pulmonary valve stenosis, systemic hypertension,

pulmonary hypertension)

 Constriction of the ventricles (e.g. cardiac tamponade, pericarditis, restrictive

cardiomyopathies)

Classification:

 Backward heart failure (Right-sided heart failure) – results from damming up of blood in
the vessels proximal to the heart.

 Forward heart failure (Left-sided failure) – results from inability of the heart to maintain
cardiac output

Right-sided heart failure means that the right side of the heart is not pumping blood to the lungs as
well as normal. It is also called cor pulmonale or pulmonary heart disease.
The most common cause of right-sided heart failure is actually left-sided heart failure. But other
conditions, such as certain lung diseases, can cause the right ventricle to fail even when there is no
problem with your left ventricle.

Diagnostic Tests:

 Blood tests

 Electrocardiogram (ECG)

 Echocardiogram

 Chest X-ray

Global and National Significance

 According to Center for Disease Control and Prevention (CDC), about 5.7 million adults in
the United States have heart failure and about half of people who develop heart failure die within 5
years of diagnosis. In the Philippines, heart failure is the most common cause of hospitalization in
people aged over 65.

Date of Assessment: October 15, 2019

 Patient History & General Information
Name of Patient: Patient E Age: 65 Sex: Female

Marital Status: Married Religion: N/A Date/ Time Admitted: October 15, 2019, 3:00 a.m.

Information Provided by: Relative

History of the Present Illness

Chief Complaint: Difficulty of Breathing, Chest pain

Summarized Current Illness: Last October 3, the patient was admitted in Metro Lemery Medical
Center due to difficulty of breathing and chest pain. Several tests and procedures were performed
to the patient including CBC, ECG, X-ray and 2D echo. According to the daughter of the patient,
the x-ray revealed presence of fluid in the lungs of the patient. The patient was diagnosed with
COPD (Emphysema) and Congestive Heart Failure. The patient was given antibiotics and was
referred to sought consultation from a cardiologist in Batangas Medical Center.

Past Medical History

Family History

As stated by the daughter of the patient, the patient’s mother died of Congestive Heart Failure.
No other history of illness.
Past Medical History & Surgical History

No history of other illness and hospitalization.

Food/ Drug Allergies

N/A

Biophysical, Psychosocial & Functional Assessment

SYSTEM FINDINGS

Poor capillary refill, edema in the lower extremities

Cardiovascular Assessment

Rapid shallow breath, respiratory rate of 30 breaths per

Respiratory Assessment minute, use of accessory muscle, wheezes

Pale, cold skin

Integumentary Assessment

III. Normal Anatomy and Physiology

The Heart

The heart itself is made up of 4 chambers, 2 atria and 2 ventricles. De-oxygenated blood returns to the
right side of the heart via the venous circulation. It is pumped into the right ventricle and then to the
lungs where carbon dioxide is released and oxygen is absorbed. The oxygenated blood then travels
back to the left side of the heart into the left atria, then into the left ventricle from where it is pumped
into the aorta and arterial circulation.

Image: The passage of blood through the heart

The pressure created in the arteries by the contraction of the left ventricle is the systolic blood
pressure. Once the left ventricle has fully contracted it begins to relax and refill with blood from the
left atria. The pressure in the arteries falls whilst the ventricle refills. This is the diastolic blood
pressure.

The atrio-ventricular septum completely separates the 2 sides of the heart. Unless there is a septal
defect, the 2 sides of the heart never directly communicate. Blood travels from right side to left side
via the lungs only. However the chambers themselves work together . The 2 atria contract
simultaneously, and the 2 ventricles contract simultaneously.

IV. Pathophysiology
 The patient was diagnosed with COPD (emphysema) due for chronic smoking. Emphysema
causes damage to the lung tissues specifically in the alveoli. When alveoli are poorly oxygenated, the
corresponding pulmonary arterioles vasocontrict and divert blood away from it. When lots of alveoli
are poorly ventilated, they vasocontrict causing increased resistance leading to pulmonary
hypertension. The high pulmonary pressure makes it difficult for the right ventricle to pump blood in
the pulmonary circulation. Prolonged high pressure results to right ventricle hypertrophy. The
increase in right ventricular mass also means there is a greater demand for oxygen. The coronary
arteries get squeezed down by the extra muscle so lesser blood is delivered to the right ventricle.
More demand and reduced supply makes the right ventricle ischemic.

References:

Udan, J. (2017). Medical-Surgical Nursing: Concepts and Clinical Applications. Manila: APD
Educational Publishing House

Cardoivascular Institute of the South. (2017, November 21). Retrieved October 17, 2019 from
https://www.cardio.com/blog/copd-and-heart-failure-what-are-the-symptoms-and-how-are-they-
related

Lung Institute. (2019). Retrieved October 17, 2019 from https://lunginstitute.com/blog/the-

relationship-between-copd-and-heart-problems/