What Is Right Heart Failure?

Sometimes we can recognize warning signs of our body in everyday things: the otherwise super-fitting elegant loafers have to be exchanged for extra-wide health shoes from the medical supply store? The responsible swollen feet can be a first symptom of right-sided heart failure, also called right heart failure. What happens to this form of heart failure in the body and how to recognize Right Heart Failure, read now.

Symptoms of Right Heart Failure

Simply put, in right heart failure, the right half of the heart is no longer working properly. This is often the result of advanced left heart failure. If the two forms come together, it is also called global heart failure. When it comes to the chronic form, the symptoms of heart failure can go unnoticed for a long time right. Common signs of right heart failure include:

    • Rapid weight gain and swollen ankles and feet indicate water retention in the tissues. If you press your finger on the thickened area, a dent remains that can last for several minutes.
    • Caution: A thrombosis (blood clot) can also cause swelling in the leg. In contrast to this disease, in case of right heart failure, however, both legs or feet are always swollen. A thrombosis must be treated immediately.
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What happens with heart failure on the right?

Right heart failure is a weak pumping of the right half of the heart, which is responsible for the transport of oxygen-poor blood to the lungs. Normally, the right half of the heart works like this:

    1. Low-oxygen blood from the upper and lower half of the body flows into the right atrium.
    2. From the right atrium, the blood enters the right ventricle.
    3. The spent blood flows from the right ventricle into the lungs, where it is enriched with oxygen. This is called “small blood circulation”.
What happens if the right half of the heart is weakened?

This is simply explained: In right heart failure, more blood flows out of the systemic circulation than the impaired, right ventricle can carry on to the lungs. There is a backlog of spent blood in front of the right atrium, which can reach into the legs or neck. Sufferers suffer from swollen legs and thickened veins. In addition, this can increase the pressure in the veins so much that the liquid components of the blood are pressed into the surrounding tissue. This causes water retention (edema) in the feet, abdomen or other parts of the body.

Diastolic Dysfunction Heart Failure, Diagnostics, and Treatment

Diastolic cardiac insufficiency exists when signs and symptoms of heart failure are present, but the left ventricular systolic function is still preserved (ejection fraction above 45%). It is important to differentiate the diastolic from the systolic heart failure so that it can be optimally treated.

The incidence of diastolic heart failure increases with age; in about 50 percent of elderly patients with heart failure, there is isolated diastolic dysfunction, write Chhabi Satpathy and colleagues in the American Family Physician. If diastolic dysfunction is diagnosed early and adequately treated, the prognosis is better than for systolic dysfunction.

Diastolic heart failure is clinically and radiologically indistinguishable from systolic heart failure. However, if there is a normal ejection fraction and an abnormal diastolic function with signs and symptoms of heart failure, diastolic heart failure can be diagnosed. Unlike systolic, diastolic heart failure can occur in isolation. Common causes of diastolic dysfunction include cardiac ischemia, hypertension, aging, obesity and aortic stenosis. Rarely, the disorder is caused by myocardial diseases such as cardiomyopathy, storage diseases and amyloidosis or sarcoidosis or by a disease of the pericardium.

In isolated diastolic dysfunction, there is a disorder of isovolumic ventricular relaxation and decreased compliance of the left ventricle. The transmission of higher end-diastolic pressures into the pulmonary circulation can cause pulmonary congestion leading to dyspnea and eventually right heart failure.

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Diagnostics

Heart failure may be manifested by fatigue, exertional dyspnoea, paroxysmal nocturnal dyspnea, orthopnea, cervical venous stasis, rales, tachycardia, third or fourth heart sounds, hepatomegaly, and edema. Cardiomegaly and congestion of the pulmonary veins often occur in chest radiographs, but these findings are non-specific and can also occur in non-cardiac diseases. It is difficult to distinguish diastolic from systolic heart failure on the basis of physical examination alone.

Two-dimensional Doppler echocardiography is of great importance in the diagnosis of diastolic heart failure. This study not only provides important information about ventricular size, myocardium, heart valves, systolic function and pericardium, but also provides information on diastolic transmitral and pulmonary venous blood flow. In echocardiography, the peak velocity of blood flow through the mitral valve in the early diastolic filling phase corresponds to the e-wave. The atrial contraction corresponds to the A-wave. From these values, the I / O quotient is calculated. Usually E is greater than A, and the I / O ratio is about 1.5.

In early diastolic dysfunction, relaxation is disturbed and the I / O ratio drops to less than 1.0 with atrial contraction. As the disease progresses, left ventricular compliance decreases, increasing left atrial pressure and early left ventricular filling despite disturbed relaxation. This paradoxical normalization of the I / O quotient is called “pseudo-normalization”. In patients with severe diastolic dysfunction, the left ventricle is filled, especially in early diastole, resulting in an I / O ratio above 2.0. Although cardiac catheterization is preferred in the diagnosis of diastolic dysfunction. However, two-dimensional Doppler echocardiography has proven to be the best noninvasive method in everyday clinical practice. Rarely, radionuclide angiography is performed, especially in patients who find echocardiography technically difficult.

Treatment

Primary prevention of diastolic heart failure includes nicotine abstinence and the aggressive treatment of high blood pressure, hypercholesterolemia and coronary heart disease. Lifestyle changes such as weight loss, cessation of smoking, diet change, restriction of alcohol intake and physical activity serve to prevent diastolic and systolic heart failure. Diastolic dysfunction can remain asymptomatic for many years. Early diagnosis and treatment are important to prevent irreversible structural changes and systolic dysfunction. At first glance, it seems that the treatment of diastolic and systolic heart failure is not very different. However, the treatment of diastolic heart failure is limited due to the lack of large randomized controlled trials. In addition, optimal treatment for systolic heart failure may result in exacerbation of diastolic heart failure.

Improvement of the left ventricular function

For diastolic dysfunction, it is important to control the heart rate and prevent tachycardia to maximize the diastolic filling period. Beta-blockers are particularly useful for this purpose, but they do not directly affect myocardial relaxation. Beta blockers should be used in particular for the treatment of diastolic heart failure, if a high blood pressure, coronary heart disease or arrhythmia.

Optimization of hemodynamics

Hemodynamic optimization is achieved primarily by reducing cardiac preload and afterload. ACE inhibitors and angiotensin receptor blockers directly affect myocardial relaxation and compliance by inhibiting the formation of angiotensin II or blocking angiotensin II receptors, thus preventing interstitial collagen deposition and fibrosis. A Hemodynamic optimization also results in better filling of the left ventricle. and lowering blood pressure. In addition, there is an improvement in exercise capacity and quality of life.

Diuretics may provide optimal intravascular volume in diastolic dysfunction patients, minimize dyspnoea, and prevent acute heart failure. Although diuretics control blood pressure, lead to regression of left ventricular hypertrophy and reduce left ventricular stiffness, some patients with diastolic heart failure are sensitive to preload and develop hypotension or severe prerenal azotemia.

The hormone aldosterone promotes cardiac fibrosis. The aldosterone antagonist spironolactone (Aldactone® or generic) has been studied in a large clinical trial in patients with systolic heart failure. There has been a reduction in heart failure-associated mortality, but the specific effects of spironolactone on diastolic dysfunction are unclear.

Calcium antagonists directly improve diastolic function through myocardial relaxation and indirectly by lowering blood pressure and heart rate, reducing myocardial ischemia, and promoting regression of left ventricular hypertrophy. However, non-dihydropyridine-type calcium antagonists such as verapamil (Isoptin® or generics) and diltiazem (Dilzem® or generic) should not be used in patients with left ventricular dysfunction. Long-acting dihydropyridines such as amlodipine (Norvasc® or generic) should only be used to control heart rate and angina pectoris, If beta blockers are contraindicated or ineffective.

Vasodilators such as nitrates and hydralazine may be useful because of their anti-ischemic and preloading effects, especially if ACE inhibitors can not be used. However, vasodilators should be used with caution as a reduction in preload may reduce cardiac output.

Everything You Should Know About Chronic Bronchitis, Causes, Symptoms And Therapy

Persistent coughing with sputum indicates chronic bronchitis. Smoking is the most important risk factor. Those who ignore the signs risk serious lung disease.

In short, what is chronic bronchitis?

Chronic bronchitis means that the bronchi are permanently inflamed. According to the World Health Organization (WHO), bronchitis is considered to be chronic if the symptoms of cough and sputum persist for two consecutive years for at least three months each year.

The bronchi are the continuation of the trachea. It divides into two main bronchi at the lower end. These lead the breathing air into the two lungs. There, the bronchi branch out ever finer until they end in the microscopic small alveoli, where the actual gas exchange, ie the vital intake of oxygen and release of carbon dioxide takes place.

Approximately ten percent of the population suffer from chronic bronchitis during their lifetime. Smoking is considered the biggest risk factor (colloquially “smoker’s cough”), but there are also many other triggers, which is why a reduction in smoking behavior falls short.

The most important therapy measure for smokers is the smoke stop. Various medications, adapted sports and special breathing techniques can help additionally.

Chronic bronchitis can lead to COPD – a chronic obstructive pulmonary disease. The airways are then permanently constricted and alveoli are broken down (emphysema). Read more about it in the COPD guidebook and in the guide to emphysema.

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Causes and risk factors: How does chronic bronchitis develop?

Risk of tobacco smoke: Smoking is the leading cause of chronic bronchitis. Tobacco smoke damages the respiratory tract in different ways: First, it destroys the cilia in the bronchial mucosa. These normally transport mucus and pollutant particles contained therein and thus exercise a cleaning function. On the other hand, tobacco smoke promotes inflammatory processes, weakens the immune system and causes more mucus to be formed in the bronchi. Especially at night while lying down secretions accumulate, which leads to morning cough with sputum. Passive smoking also increases the risk of chronic bronchitis.

Air pollutants: Certain gases, dusts and vapors pollute some people in the workplace. These pollutants can also cause lung problems and cause chronic bronchitis.

Common respiratory infections: Bacterial and viral infections are more common in chronic bronchitis. It often remains unclear whether they are the cause or the consequence of the respiratory disease.

Genetic causes: A certain genetic component can be identified in chronic bronchitis and its consequences. Alpha-1-antitrypsin deficiency, which increases the risk of pulmonary emphysema and may be associated with symptoms of chronic bronchitis, cystic fibrosis, where lung involvement often begins as chronic bronchitis, and ciliary disorder, in which mutations are either missing or defective, are well characterized Formation of the cilia on the bronchial mucosa leads.

Other underlying diseases: Certain diseases are associated with chronic bronchitis. It is usually hard to recognize cause and impact. Examples are asthma, chronic sinusitis and pulmonary tuberculosis. A hyperreactive bronchial system, as is typical in people with an allergy, may in rare cases favor chronic bronchitis.

Is chronic bronchitis contagious?

Chronic bronchitis is not intrinsically contagious – unlike acute bronchitis, which is often the case. If respiratory tract infections occur as part of chronic bronchitis, they can be contagious.

Symptoms: How is chronic bronchitis noticeable?

The classic symptom of chronic bronchitis is coughing with expectoration of viscous mucus. The cough occurs especially in the morning.

Chronic bronchitis often begins insidiously and may initially go unnoticed. Because a clogged cough that lasts for a long time, sufferers often lead back to a supposedly harmless, perhaps “abducted” cold. They do not take the symptom seriously.

Chronic bronchitis can be fluent in COPD. If there is shortness of breath and tightness of the chest during physical exertion, this is a possible sign that COPD has already developed. However, there may be other causes behind such symptoms, such as angina pectoris.

When is a bronchitis chronic?

According to the WHO definition, it is a chronic bronchitis if the symptoms of coughing and expectoration occur for two consecutive years for at least three months a year most days of the week.

What is an exacerbation?

Doctors speak of an exacerbation when the patient’s complaints suddenly worsen. This occurs especially in advanced disease and during the cold season. In the majority of cases respiratory infections are the trigger. If very severe COPD is present, an exacerbation can be life-threatening.

Important: Take respiratory symptoms seriously. See the doctor if symptoms persist like coughing persistently or if shortness of breath occurs.

Chronic bronchitis: What are the consequences of the disease?

If chronic bronchitis progresses, this can have negative consequences:

Pulmonary emphysema: Pulmonary emphysema mainly affects the pulmonary alveoli of the lungs. They are indispensable for the absorption of oxygen. In pulmonary emphysema, they gradually merge into larger bubbles, the walls of the alveoli are degraded. Air remains trapped in the lungs. In addition, the inner surface of the lung continues to decrease. Although the respiratory muscles become more active, the gas exchange remains insufficient. This creates the feeling of shortness of breath or shortness of breath. Emphysema can not be undone. Read more in the guide Counselor Lungenemphysem.

Right heart failure (weakness of the right ventricle): In pulmonary emphysema, the blood vessels in the lungs are partly degraded, sometimes narrow. The blood must flow through fewer and narrower vessels. This is only possible by increased pressure, a pulmonary hypertension arises. The right ventricle of the heart needs to apply more force to pump the blood into the lungs. The heart enlarges, the muscle mass increases, it does not work more efficiently. This leads to right heart failure with symptoms such as shortness of breath and swollen legs.

Diagnosis: How to recognize a chronic bronchitis?

Information on complaints, medical history and lifestyle of the person concerned provide the doctor with first clues. Next, he listens and pats the patient’s chest. Under certain circumstances, a whistling or humming noise can be heard when exhaling, with secretion in the bronchi you can hear rattling breath sounds even during inhalation.

The diagnosis of chronic bronchitis is essentially based on the information provided by the patient. However, the doctor must rule out other diseases as a possible cause of the symptoms, for example, asthma, pneumonia, pulmonary embolism, lung cancer, tuberculosis or heart disease. Different investigations may be required. Chronic cough can also be a side effect of certain medications (antihypertensive drugs: ACE inhibitors) and is often associated with heartburn and reflux. More in the guidebook gastroesophageal reflux disease.

It is important to recognize the onset of bronchoconstriction as early as possible so that the disease is still treatable. Therefore, the doctor checks the lung function with a lung function test, spirometry. The patient blows with maximum force into a meter, after he has inhaled deeply. Among other things, this method is used to determine the characteristic value “FEV1”: the forced exhaled (exhaled) volume in the first second. The FEV1 value in relation to the total exhaled air (so-called expiratory, forced vital capacity, FVC) provides information on whether the airways are narrowed or how much the breathing is impaired. Read more in the text Spirometry. With the help of whole-body plethysmography, the bronchial constriction and the extent of pulmonary hyperinflation can be recorded more accurately and also during quiet, normal breathing. A whole body plethysmography is usually performed only by the lung specialist.

A blood gas analysis can be used by the doctor to check the oxygenation of the organism and the exhalation of the carbon dioxide.

Exercise tests (bicycle or treadmill ergometry, spiroergometry) often show changes in lung function more clearly and earlier than at rest.

If an infection is suspected, the doctor can also have a sample of the morning sputum (sputum sample) examined for germs and make an X-ray of the lung – the latter can also make a bronchial carcinoma visible.

Furthermore, if necessary, diagnostic procedures such as a blood sample, a bronchoscopy (lung reflection) or an ECG (electrocardiogram) are eligible.

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Therapy: What helps with chronic bronchitis?

Stop Smoking / Exposure Stop: Anyone who stops smoking can slow the progression of chronic bronchitis. Already three days after the last cigarette, the lung function improves. Over time, coughing subsides, the bronchi make less mucus. The lung cancer risk is reduced significantly. Those exposed to other pollutants in the air should try to avoid them in the future.

Medications: They do not fight the cause of chronic bronchitis. But they can alleviate symptoms and improve well-being. The exact therapy depends, among other things, on the severity of the disease. With a low severity of COPD, the doctor prescribes short-acting bronchodilating drugs (beta-sympathomimetics or anticholinergics). The patient can take them if necessary when he feels a need for air. If the disease progresses, usually long-acting bronchial dilating sprays are added, which the patient uses regularly. In addition, the doctor may prescribe a cortisone preparation. Cortisone has anti-inflammatory effects. You can read more about the treatment of COPD in the guidebook COPD.

Further measures

Respiratory Physiotherapy: Special breathing techniques (such as the so-called “lip brake”) and a posture that facilitates breathing contribute to maintaining quality of life and resilience despite impaired lung function.

Exercise: Physical training is a central part of the therapy. Anyone who practices adapted sport – for example in a lung sports group – can best maintain the resilience and functionality of their body. Regular physical activity also reduces the risk of exacerbation, ie a sudden worsening of bronchitis symptoms. The sport should take place under medical supervision, so that the patient is not overwhelmed.

Diet: Overweight influences the course of the disease as well as underweight. Especially the latter is accompanied by an unfavorable prognosis. An adapted diet should be done in collaboration with a nutrition expert.

Healing chances: is a chronic bronchitis curable?

Chronic bronchitis can completely recede in the early stages. Thus a cure is possible in principle. The decisive factor is that those affected eliminate smoking or other inhaled pollutants. However, if the bronchi are already constricted, so that a COPD has developed, the disease can no longer be completely cured. However, the course and the life expectancy can be positively influenced – by a consistent therapy.