Heart Failure: Left-Sided vs Right-Sided

Understanding Heart Failure

Heart Failure Overview: Heart becomes weak and fails to pump blood effectively, leading to fluid volume overload and backup of blood.
Heart Anatomy:
- Left Side: Connected to lungs (pulmonary circulation).
- Right Side: Connected to venous circulation.

Function: Receives deoxygenated blood from venous system.
Failure: Causes congestion, increasing pressure in vena cava and causing venous congestion.
Symptoms:
- Hepatomegaly & Venous Congestion: Jugular venous distention (JVD), swelling in extremities (legs, feet), and abdomen (ascites).
- Mnemonic "SWELLING":
  - S: Swelling (legs, feet, abdomen - ascites)
  - W: Weight gain (early sign, monitor daily weights)
  - E: Edema (pitting edema in lower extremities)
  - L: Large neck veins (JVD)
  - L: Lethargy (weakness, tiredness due to poor cardiac output)
  - I: Irregular heartbeat (risk for atrial fibrillation)
  - N: Nausea (congestion of liver affects appetite)
  - G: Girth of abdomen (increased from liver swelling, fluid buildup)

Function: Pumps oxygenated blood into arterial circulation.
Failure: Blood backs up into lungs, causing pulmonary congestion.
Types:
- Systolic Heart Failure: Reduced ejection fraction, left ventricular systolic dysfunction.
  - Ejection Fraction (EF): Measures severity of heart failure. Normal EF > 50%, heart failure EF ≤ 40%.
- Diastolic Heart Failure: Preserved ejection fraction, left ventricular diastolic dysfunction.
  - Filling Issue: Stiff ventricle, normal contraction.
Symptoms:
- Pulmonary Signs: Result from fluid backup in lungs.
- Mnemonic "DROWNING":
  - D: Difficulty breathing
  - R: Rales (crackles, indicative of pulmonary edema)
  - O: Orthopnea (difficulty breathing when lying flat)
    - Management: High Fowler's position, dangle feet to reduce preload.
  - W: Weakness (poor cardiac output)
  - N: Nocturnal paroxysmal dyspnea (sudden night-time breathing difficulty)
  - I: Increased heart rate (sinus tachycardia, due to fluid overload)
  - N: Nagging cough (early sign, monitor for frothy, blood-tinged cough)
  - G: Gaining weight (monitor for fluid overload)

Daily Weights: Essential for both types of heart failure to monitor fluid retention.
Ejection Fraction Check: Utilize diagnostic tools such as echocardiograms.
Patient Education: Recognize early signs and symptoms for timely medical attention.