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Discussion

Rt vs Lt heart failure

I am having trouble with remembering the differences between right & left heart failure as far as symptoms. Is peripheral edema a manifestion of both? Any mnemonic help? TIA.

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    I believe RT sided HF are signs and LT sided are symptoms. RT side ie: edema, jugular vein distension

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    I always remember heart failure by the following:Right - the rest of the body (this would be the peripheral edema)Left - lungsHope this helps!

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    In left side there will always be pulmonary problems. In rt., mostly there is peripheral edema. Left is almost always the cause of right. Hope this helps!

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    sports2245 said:
    I am having trouble with remembering the differences between right & left heart failure as far as symptoms. Is peripheral edema a manifestion of both? Any mnemonic help? TIA.

    That's good. Signs are what you see ( pedal edema) & symptoms are what the pt complains of (trouble breathing).

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    I remember what side heart failure causes what by:

    L=Lungs (and all things pulmonary related)

    R=Rest of body

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    • Experts
    sports2245 said:
    I am having trouble with remembering the differences between right & left heart failure as far as symptoms. Is peripheral edema a manifestion of both? Any mnemonic help? TIA.

    No. Peripheral edema is NOT a manifestation of both types of heart failure. It is a manifestation of right-sided heart failure.

    Heart failure is a gradual progressive condition. It starts and proceeds as follows:

    1. left-sided heart failure
      • ineffective left ventricular contractile function
        • increased workload and end-diastolic volume enlarge the left ventricle

    [*]pumping ability of the left ventricle fails, cardiac output falls

    • right ventricle becomes stressed because it's pumping against greater pulmonary vascular resistance and left ventricle pressure

    [*]blood backs up into left atrium and then into lungs

    • diminished function allows blood to pool in the ventricle and atrium and back up into the pulmonary veins and capillaries
    • rising capillary pressure pushes sodium and water into interstitial spaces
    • fluid in the extremities moves into the systemic circulation

    [*]Signs and symptoms

    • dyspnea
    • orthopnea
    • paroxysmal nocturnal dyspnea
    • reduced sympathetic stimulation while sleeping
    • pulmonary congestion
    • tachycardia
    • S3
    • S4
    • Cool, pale skin
    • restlessness

    [*]right-sided heart failure

    • ineffective right ventricular contractile function
      • stressed right ventricle enlarges with the formation of stretched tissue

      [*]blood backs up into right atrium and peripheral circulation

      • blood pools in the right ventricle and right atrium
      • backed-up blood also distends the visceral veins

      [*]patient gains weight and develops peripheral edema

      • rising capillary pressure forces excess fluid from the capillaries into the interstitial space

      [*]Signs and symptoms

      • jugular vein distention
      • positive hepatojugular reflux
      • hepatomegaly

    [*]systolic dysfunction

    • left ventricle can't pump enough blood out to systemic circulation
    • blood backs up into pulmonary circulation and pressure increases in pulmonary venous system
    • cardiac output falls; weakness and fatigue occur

    [*]diastolic dysfunction

    • ability of left ventricle to relax and fill during diastole is reduced and stroke volume falls
    • high volumes needed in ventricles to maintain cardiac output

    The above information comes from Pathophysiology: A 2-in-1 Reference for Nurses, pages 182-185.

    Two terms connected with heart failure are preload and afterload. End-diastolic stretch is known as preload; afterload is the stress or tension that develops in the ventricular wall during systole. You need to develop a good understanding of heart failure, preload and afterload and how they all relate because all this information is at the basis of understanding the nursing diagnosis of Decreased Cardiac Output. Students are always asking what nursing diagnosis to use with certain medical diagnoses. Decreased Cardiac Output is used for any of the heart failures including congestive heart failure.

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    Just think of what comes before the right side of the heart - what would be affected - and what comes after the left side of the heart - what would be affected.

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    sports2245 said:
    I am having trouble with remembering the differences between right & left heart failure as far as symptoms. Is peripheral edema a manifestion of both? Any mnemonic help? TIA.

    Just think of the circulatory system like a big circle. Blood leaves the left side of the heart and goes into the systemic circulation. The blood from the systemic circulation goes into the right side of the heart. From the right side of the heart, blood goes to the pulmonary circulation, then to the left side of the heart. Big circle.

    Now think about where in the circle the problem is. If the problem is in the left side of the heart, what is directly behind it? The pulmonary circulation. If the problem is in the right side of the heart, what is directly behind that? The systemic circulation. That is where your signs and symptoms will manifest.

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    - usually left-sided heart failure develops initially then right-sided failure occurs.

    - [color=#d419ff]left-sided failure: (forward failure);the left ventricle has reduced capacity to pump blood into the systemic circulation causing decreased co and stasis or "backup" of blood into the pulmonary circulation. congestion occurs mainly in the lungs from blood backing up into pulmonary veins and capillaries (pulmonary venous congestion)

    o signs and symptoms

    o shortness of breath. dyspnea on exertion

    o paroxymal nocturnal dyspnea - due to reabsorption of independent edema that has developed during the day.

    o orthopnea

    o pulmonary edema

    o cough - may be dry, nonproductive, usually occurs at night.

    o fatigability - from low co2. nocturia, insomnia, dyspnea. restlessness.

    o tachycardia, s3 venticular gallop.

    - [color=#d419ff]right-sided failure: (backward failure); is the result of ineffective right ventricular contraction. results in inadequate right ventricle output and systemic venous congestion (peripheral edema).

    - increased pressure from left-sided heart failure.

    - increased venous pressure in the systemic circulation with fluid overload.

    - signs and symptoms

    o jugular vein distention

    o anorexia, nausea and vomiting

    o ascending dependent edema, peripheral edema

    o abdominal distention

    o hepatomegaly

    o signs of right-sided failure

    o gallop rhythm: s3, s4

    o tachycardia, nocturia

    o weight gain

    remember - with right side you always get peripheral edema - there is edema all over

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