Right heart failure history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jad Z Al Danaf; Rim Halaby
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Overview
Right heart failure is frequently associated with shortness of breath, exercise intolerance and coughing, and in later stages chest discomfort and swelling of the feet or ankles. According to the recent 2009 updated guidelines on diagnosis and management of right heart failure published by the Canadian Cardiovascular Society Consensus Conference guidelines, right heart failure should be suspected as the diagnosis whenever a patient is presenting with unexplained complaints of exercise intolerance or hypotension with signs of elevated jugular venous pressure (JVP), peripheral edema (feet or ankles), hepatomegaly or a combination of any of these clinical signs.[1]
Symptoms
- Symptoms of right heart failure are:
- Asymptomatic
- Abdominal/epigastric pain
- Chest discomfort, usually in the front of the chest
- Cold extremities
- Dizziness
- Exercise intolerance
- Fatigue
- Nausea
- Shortness of breath
- Swelling of the feet or ankles
- Symptoms of underlying disorders (wheezing, coughing)[2]
- In addition to the above, other symptoms might also be evident such as hemoptysis, paroxysmal nocturnal dyspnea, orthopnea, excessive daytime somnolence, and apneic episodes during sleep. These symptoms provide hints towards the underlying disease causing the right heart failure which helps in directing the management plan.
- Social and occupational history is also important in an approach to a patient with heart failure especially exposure to smoking, illicit drug use (intra venous, inhaled), occupational dust or chemical exposure (asbestos), pet exposure, travel history and any infectious history like Chagas disease. Many of these questions might relate to an underlying pulmonary disorder that causes pulmonary hypertension and secondarily right heart failure due to pressure overload as one proposed mechanism [3].
References
- ↑ JG Howlett, RS McKelvie, JMO Arnold, et al. Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: Diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials. Can J Cardiol 2009;25(2):85-105.
- ↑ Piazza G, Goldhaber SZ (2010). "Management of submassive pulmonary embolism". Circulation. 122 (11): 1124–9. doi:10.1161/CIRCULATIONAHA.110.961136. PMC 2941210. PMID 20837937.
- ↑ McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, Mathier MA, et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association. J Am Coll Cardiol. 2009;53:1573-619