Right Sided Heart Failure

It's often difficult to differentiate right sided heart failure from left sided - because left goes on to cause right!

Pathophysiology

http://calgaryguide.ucalgary.ca/right-heart-failure/

Caused by respiratory problems, and by progression of left sided heart failure. 

Signs

High JVP

Pitting oedema

RUQ pain - hepatomegaly 

Loud P2, and heave 

Investigations

ECG: If the ECG is normal, heart failure is unlikely

  Reduced ECG amplitude (more air between heart and leads)

  Prominent P waves

  Right axis deviation

  RBBB (Broad QRS > 120 ms, RSR’ pattern in V1-3 (‘M-shaped’ QRS complex), Wide, slurred S wave in the lateral leads (I, aVL, V5-6))

  Sagging of ST segment below baseline 

http://lifeinthefastlane.com/ecg-library/basics/p-wave/

P Waves: 

P mitrale (bifid P waves), seen with left atrial enlargement.

P pulmonale (peaked P waves), seen with right atrial enlargement.

P wave inversion, seen with ectopic atrial and junctional rhythms.

Variable P wave morphology, seen in multifocal atrial rhythms.

--> if P waves are inverted check lead placement

Management

Reduce hypoxia and hypercarbia

Ventilation and PEEP

Inotropes and vasopressors

RV assist device may be useful 

http://lifeinthefastlane.com/ecg-library/copd/

http://lifeinthefastlane.com/ecg-library/basics/p-wave/

http://lifeinthefastlane.com/ccc/right-ventricular-failure/
http://www.rcemlearning.co.uk/references/pulmonary-hypertension-and-right-heart-failure/

http://www.rcemfoamed.co.uk/portfolio/rcem-belfast-day-3/