Pathophysiology and Complications of Right- and Left-Sided Heart Failure

Pathophysiology and Complications of Right-Sided and Left-Sided Heart Failure

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Overview of Heart Failure

Pathophysiology and Complications of Right-sided and Left-sided Heart Failure

Heart Failure is a condition characterized by the loss of the ability of heart to pump blood (Mandras and Desai, 2020). The heart is a structure with three major layers, pericardium, myocardium and endocardium. Any pathology in any of these structures can lead to Heart Failure (Chahiney and Alvey, 2020). This paper peeks into the pathophysiology and Complications of both right-and-left-sided Heart Failure. 

Right-Sided Heart Failure

Right Heart Failure is a condition commonly resulting from the left ventricular failure owing to volume and pressure overload (Mandras and Desai, 2020). Clinically, the patient presents with the signs and symptoms of breathlessness, chest discomfort, body swelling, and palpitations (Mandras and Desai, 2020). Right Heart Failure is evaluated by non-invasive techniques like echocardiography, CT, MRI and nuclear angiography. 

Pathophysiology of Right Heart Failure

Normally, the Right ventricular function is an interplay between pre-load, after-load, contractility, ventricular-interdependence and cardiac rhythm (Arrigo et al., 2019). In most of the cases of Right Ventricular failure, there is an existing or new-onset cardiac or pulmonary diseases or there could be a combination of both that can lead to increase in Right Ventricular Afterload or may reduce its contractibility, alter Right Ventricular pre-load or Ventricular interdependence or lead to cause-related arrhythmias (Arrigo et al., 2019). Thus, these may lead to Right Heart Failure. 

Complications of Right Heart Failure

The complications of Right Heart Failure can be; Angina, Atrial Fibrillation, Cardiac Cachexia, Heart Attack, Impaired Kidney function, Heart Valve issues, liver to name a few (Baptisthealth, n.d.). 

Left-Sided Heart Failure

Left-sided heart failure or Left Heart Failure is a condition that occurs because of the dysfunction of the left ventricle, resulting in insufficient delivery of blood from heart to the vital organs (Chahiney and Alvey, 2020). Left Ventricular Failure has further subdivisions such as Heart Failure with preserved ejection fraction (HFpEF), Heart failure with ejection fraction over 50 percent, heart failure with ejection fraction lesser than 40 percent or reduced ejection fraction (HFrEF). Heart failure with Ejection fraction between the ranges 41 to 49 percent is called heart failure with mid-range ejection fraction (Chahiney and Alvey, 2020).

Pathophysiology of Left Heart Failure

Left Heart Failure can occur because of wide range of mechanisms. For instance, chronic hypertension can cause increased afterload, leading to increased cardiac workload, which eventually leads to left ventricular hypertrophy (Chahiney and Alvey, 2020). Initially, the mechanism can act as a compensatory mechanism to maintain cardiac output, but in the long run, it can inhibit relaxation of the myocardium, thereby leading to impaired cardiac filling and a decreased left ventricular output (Chahiney and Alvey, 2020). Other mechanisms, like coronary artery disease, in which there is direct ischemic damage to the myocardium can lead to Left Heart Failure. Arrhythmias and Cardiomyopathies entail other diverse pathologic spectrum and mechanisms that can lead to left ventricular cardiac dysfunctions and ultimately, Left Heart Failure (Chahiney and Alvey, 2020).

Complications of Left Heart Failure

Left Heart Failure is often complicated with an exaggerated volume overload that can lead to respiratory distress, anasarca and arrhythmias, cardiogenic shock, pump failure and even death (Chahiney and Alvey, 2020). Some other complications of Left Heart Failure can be Pulmonary Embolism, Cerebrovascular accidents, rupture of myocardium, that can lead to death (Chahiney and Alvey, 2020). 

Conclusion

Heart Failure is a complex disease characterized by the failure of the cardiac muscles to pump blood. It can be categorized into Right and Left ventricular Heart Failure. While the pathophysiology of Right Heart Failure involves its interdependence on the Left heart Failure, left ventricular Failure on the other hand, can occur because of underlying pathologies like Chronic Hypertension, Arrhythmias and Cardiomyopathies. The Complications of Heart Failure can be respiratory disease, impaired kidney function, to name a few.

References

Arrigo et al., (2019) Right Ventricular Failure: Pathophysiology, Diagnosis and Treatment.

Card Fail Rev. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848943/

Baptisthealth.com (n.d.). Right-Sided Heart Failure (Cor Pulmonale). Baptist Health. 

Available at https://www.baptisthealth.com/services/heart-care/conditions/right-sided-heart-failure

Chahiney, J. and Alvey, H. (2020) Left Ventricular Failure. StatPearls. Available at

https://www.ncbi.nlm.nih.gov/books/NBK537098/#article-24161.s5

Mandras, S.A. and Desai, S. (2020) Right Heart Failure. StatPearls. Available at

https://www.ncbi.nlm.nih.gov/books/NBK459381/#article-28595.s5