Right Ventricular Failure

• RVF:

  • hyper-perfusion/congestion of the preceding system - systemic hyper-perfusion/congestion
  • hypo-perfusion of the succeeding system - pulmonary hypo-perfusion
• RVF - clinical features pt1:

  • a lot of the signs and symptoms of right ventricular failure, of venous congestion, are secondary to oedema
  • systemic venous congestion ->
  • systemic oedema - due to increased pressure/congestion in systemic venous circulation -> increased pressure/congestion is transmitted to capillaries -> disruption of starlings forces -> increase in hydrostatic pressure -> driving fluid across capillary walls into surrounding tissue. Can be seen most commonly around the ankle
  • nocturia - lying flat at night -> redistribution of blood to central body zone -> increased congestion within venous system of kidneys -> increased pressure into surrounding capillaries -> needing to pass urine
  • pleural effusions - severity depends on size of pleural effusion and how much loss of gas exchange surface area there is
• RVF - clinical features pt2:

  • a lot of the signs and symptoms of right ventricular failure, of venous congestion, are secondary to oedema
  • systemic venous congestion ->
  • hepatomegaly - an enlarged liver due to venous congestion of veins to the liver -> congestion transmits to the veins -> oedema in the surrounding capillaries -> increasing diffusion distance for gas exchange, so also causes liver tissue to become ischemic or necrotic
  • ascites - venous congestion of the veins supplying the intestinal system and the peritoneum -> increasing congestion in surrounding capillaries -> disturbing starlings forces -> increasing hydrostatic pressure -> pushing fluid across capillary walls into tissue spaces
• RVF - clinical features pt3:

  • a lot of the signs and symptoms of right ventricular failure, of venous congestion, are secondary to oedema
  • pulmonary hypoperfusion (severe cases) ->
  • dyspnoea/exercise intolerance/fatigue
  • systemic venous congestion -> inadequate blood flow leaving the right ventricle and arising out the lungs -> inadequate oxygenation of blood -> low po2 -> dyspnoea -> chemoreceptors pick up low oxygen levels -> increase rate of breathing
  • if muscles are receiving inadequate oxygenated blood they'll convert to anaerobic metabolism -> releases hydrogen ions -> picked up by chemoreceptors -> increase rate of breathing
  • inadequate oxygenated blood flow to muscles -> fatigue