Right heart failure – a challenge to diagnose and treat patients correctly (7)

Right heart failure – a challenge to diagnose and treat patients correctly (7)

January 6, 2020 0 By Bertrand Dibbert


– What is a right heart failure?
Dr. Anton Titov MD Why right heart failure attracted less attention
previously? It’s a cause of heart failure that is very
important to determine in order to find timely and appropriate treatment? So right heart failure is really a continuum
of dysfunction of the right ventricle. We think the right ventricle is part of the
right heart system. And within that I think of the pulmonary vascular
bed, both the pre-capillary and post-capillary pulmonary vascular bed, as well as the right
atrium and the systemic veins draining into the right heart. The most common cause of right heart failure
really is left heart failure. As pressures rise in the left heart, they
backfill into the lung and ultimately affect the right heart. And the diseases that we focus on, the pulmonary
vascular diseases, where the primary dysfunction is in the blood vessels of the lung. As those vessels become stiffer and more rigid,
they cause a back fill of pressure and volume into the right heart. And the right heart is a muscle, although
it’s much more complex than the left heart. Because it has a U-shape to its inflow-outflow
tract, which changes its contractility right off the bat [from the beginning of heart muscle
contraction]. It’s also a much lower pressure and lower
resistance-high compliant system that when that compliance starts to go down and resistance
goes up, the muscle is at a disadvantage. So it starts to dilate, it starts to fibrose
and become less effective as far as contraction. And the way the right heart contracts, it’s
much more of a peristaltic contraction and down stream and kind of following this U-shape. So it’s at a disadvantage structurally relative
to the left heart. Patients who have right ventricular dysfunction
and ultimately heart failure will develop shortness of breath and then will start to
accumulate fluid. So they may get lower extremity edema first,
or they may collect fluid in their abdomen, even have frank ascites. And as time goes on it just gets worse and
worse. – You do echocardiography and additional,
perhaps invasive testing in right heart failure? And then more specific treatment is available
for right heart failure… – Yes, we do cardiac imaging. Echocardiography is certainly an easy way
to look at the heart. Although it’s not necessarily the best way
to look at the right heart, because you just can’t see all of it. Cardiac MRI is becoming very important in
how we assess right ventricular structure and function. We do right heart catheterization to get pressure
assessments and even some cardiac CT is sometimes helpful. But mostly cardiac MRI. There is no specific treatment for right heart
failure. We target the pulmonary vascular bed, we do
use some of the inotropes that we use for left heart failure. But they’re probably much less effective for
pure right heart failure than they are for the left heart. And I think that’s one of the real challenges
right now – is finding targeted therapy for the right heart failure.