Pathophysiology
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
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| 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.rcemlearning.co.uk/references/pulmonary-hypertension-and-right-heart-failure/
http://www.rcemfoamed.co.uk/portfolio/rcem-belfast-day-3/
