Left-Sided Heart Failure vs Right-Sided Heart Failure Pathophysiology Nursing NCLEX Review
Summary
TLDRIn this educational video, Sarah, a registered nurse, explains the differences between left-sided and right-sided heart failure. She describes the heart's anatomy, the causes, and symptoms of each type, using mnemonics to aid memorization. Right-sided failure presents with peripheral swelling, while left-sided failure leads to pulmonary issues. Sarah emphasizes the importance of monitoring ejection fraction and daily weights to assess heart failure severity and progression.
Takeaways
- 🧡 The heart has two sides with different functions: the left side is connected to the lungs (pulmonary circulation), and the right side is connected to the venous circulation.
- 💔 Heart failure occurs when the heart becomes too weak to pump blood effectively, leading to fluid volume overload and congestion.
- 📈 Right-sided heart failure is characterized by peripheral signs like swelling in the legs, feet, abdomen (ascites), and jugular venous distention (JVD).
- 🔁 Right-sided heart failure is often a result of left-sided heart failure, with fluid pressure backing up from the left to the right side, causing overwork.
- 📊 Signs and symptoms of right-sided heart failure can be remembered with the word 'swelling': swelling in legs, feet, abdomen, weight gain, edema, large neck veins, lethargy, irregular heartbeat, nausea, and increased abdominal girth.
- 🚫 Left-sided heart failure involves the left ventricle's inability to pump oxygenated blood into the arterial circulation, leading to pulmonary congestion.
- 🔍 Left-sided heart failure can be categorized into systolic (reduced ejection fraction) or diastolic (preserved ejection fraction) dysfunction.
- 🩺 Ejection fraction (EF) measures the heart's pumping efficiency, with a normal EF being 50 or greater and an EF of 40 or less indicating heart failure.
- 🌊 Signs of left-sided heart failure include pulmonary symptoms like difficulty breathing, crackles (abnormal sounds indicating pulmonary edema), orthopnea, weakness, nocturnal paroxysmal dyspnea, increased heart rate, nagging cough, and weight gain.
- 🛑 A nagging cough can be an early sign of heart failure and should be reported for medical attention to prevent complications like cardiogenic shock.
- 📈 Monitoring daily weights is crucial for patients with heart failure as rapid weight gain can indicate fluid retention and worsening heart failure.
Q & A
What is the primary function of the heart's left side?
-The left side of the heart is responsible for pumping oxygenated blood into the arterial circulation, which then distributes it throughout the body.
What is the connection between the right side of the heart and the body's circulation system?
-The right side of the heart receives deoxygenated blood from the venous system and pumps it to the lungs for re-oxygenation via the pulmonary circulation.
What happens in right-sided heart failure?
-In right-sided heart failure, the right side of the heart is unable to effectively pump blood, leading to blood congestion in the venous system, increased pressure in the vena cava, and symptoms like hepatomegaly, jugular venous distention (JVD), and peripheral edema.
What causes right-sided heart failure?
-Right-sided heart failure is often a result of left-sided heart failure, where increased fluid pressure backs up from the left side to the right, causing the right side of the heart to become overworked.
What mnemonic can be used to remember the signs and symptoms of right-sided heart failure?
-The mnemonic 'SWELLING' can be used, where S stands for swelling in the legs, feet, and abdomen (ascites), W for weight gain, E for edema, L for large neck veins (JVD), L for lethargic, I for irregular heartbeat, N for nausea, and G for increased girth of the abdomen.
What is the difference between systolic and diastolic heart failure in the context of left-sided heart failure?
-Systolic heart failure, indicated by a reduced ejection fraction, involves the left ventricle's inability to effectively eject blood, while diastolic heart failure, with a preserved ejection fraction, involves the ventricle being too stiff to allow for normal filling of blood.
What is an ejection fraction and why is it important in diagnosing heart failure?
-Ejection fraction is a measurement used to determine the severity of heart failure, representing the percentage of blood that the ventricles pump out with each contraction. A normal ejection fraction is 50 or greater, while an EF of 40 or less indicates heart failure.
What mnemonic can be used to remember the signs and symptoms of left-sided heart failure?
-The mnemonic 'DROWNING' can be used, where D stands for difficulty breathing, R for rales (crackles), O for orthopnea, W for weakness, N for nocturnal paroxysmal dyspnea, I for increased heart rate, N for nagging cough, and G for gaining weight.
Why is monitoring a patient's weight important in managing heart failure?
-Monitoring a patient's weight is crucial because unexplained weight gain can be an early indicator of fluid retention and potential worsening of heart failure.
What is cardiogenic shock and how can it be related to untreated heart failure?
-Cardiogenic shock is a severe condition where the heart fails to pump enough blood to meet the body's needs. Untreated heart failure can lead to the heart becoming completely overwhelmed, potentially resulting in cardiogenic shock.
Outlines
💓 Understanding Heart Failure: Left vs. Right-Sided
Sarah, a registered nurse, introduces the topic of left-sided versus right-sided heart failure. She emphasizes the importance of visualizing the heart's anatomy to comprehend how each side is connected to different circulation systems. Heart failure is characterized by the heart's inability to pump blood effectively, leading to fluid volume overload and congestion. The video delves into the specifics of right-sided heart failure, which involves the right side of the heart failing to pump deoxygenated blood, resulting in increased pressure in the vena cava and hepatic veins, causing hepatomegaly, venous congestion, and peripheral edema. Right-sided heart failure is often a consequence of left-sided heart failure, which is detailed in the next paragraph.
🔍 Signs and Symptoms of Right-Sided Heart Failure
This paragraph focuses on the signs and symptoms of right-sided heart failure, which include swelling in the legs, feet, and abdomen (ascites), weight gain as an early sign of fluid retention, and edema, particularly pitting edema in the lower extremities. It also covers jugular venous distention (JVD), lethargy due to the heart's reduced ability to maintain cardiac output, atrial fibrillation risk, nausea from liver congestion, and increased abdominal girth from liver swelling and fluid accumulation. The paragraph uses the mnemonic 'swelling' to help remember these symptoms and highlights the importance of monitoring daily weights and recognizing the early signs of fluid retention.
🌪 Left-Sided Heart Failure: Pulmonary Consequences
The video script moves on to discuss left-sided heart failure, which affects the heart's ability to pump oxygenated blood into the arterial circulation. This type of heart failure can lead to pulmonary congestion as blood backs up into the lungs, causing pulmonary edema. The paragraph differentiates between systolic and diastolic heart failure, explaining that systolic dysfunction is characterized by a reduced ejection fraction, while diastolic dysfunction involves a preserved ejection fraction due to the ventricle's stiffness during the filling phase. The importance of monitoring ejection fraction through diagnostic tests is stressed to understand the severity of heart failure. The mnemonic 'drowning' is introduced to remember the signs and symptoms of left-sided heart failure, which include difficulty breathing, crackles (abnormal lung sounds), orthopnea (difficulty breathing when lying flat), weakness, nocturnal paroxysmal dyspnea (sudden attacks of breathlessness at night), increased heart rate, and a nagging cough. The paragraph concludes with a warning about the potential progression to cardiogenic shock if left untreated.
Mindmap
Keywords
💡Heart Failure
💡Anatomy of the Heart
💡Pulmonary Circulation
💡Venous Circulation
💡Fluid Volume Overload
💡Right-Sided Heart Failure
💡Systolic Heart Failure
💡Diastolic Heart Failure
💡Ejection Fraction
💡Pulmonary Edema
💡Cardiogenic Shock
Highlights
Sarah, a registered nurse, discusses left-sided versus right-sided heart failure.
Heart failure is characterized by the heart's inability to pump blood effectively, leading to fluid volume overload.
Right-sided heart failure involves congestion in the venous system and increased pressure in the vena cava.
Signs of right-sided heart failure include hepatomegaly, jugular venous distention (JVD), and peripheral edema.
Right-sided heart failure is often a result of left-sided heart failure, causing an overworked right side.
Mnemonic 'swelling' helps remember signs of right-sided heart failure: swelling, weight gain, edema, large neck veins, lethargy, irregular heartbeat, nausea, and increased girth.
Left-sided heart failure affects arterial circulation and can be categorized into systolic or diastolic dysfunction.
Systolic heart failure is identified by a reduced ejection fraction, indicating the left ventricle's inability to eject blood properly.
Diastolic heart failure is characterized by a preserved ejection fraction despite ventricular stiffness.
Ejection fraction is a key diagnostic tool to measure the severity of heart failure, with normal values being 50 or greater.
Left-sided heart failure presents pulmonary symptoms due to fluid buildup in the lungs, resembling drowning.
Mnemonic 'drowning' for left-sided heart failure includes difficulty breathing, crackles, orthopnea, weakness, nocturnal paroxysmal dyspnea, increased heart rate, nagging cough, and weight gain.
Crackles are an abnormal sound indicating pulmonary edema in patients with heart failure.
Orthopnea is the difficulty in breathing when lying flat, a common symptom of pulmonary edema.
Nocturnal paroxysmal dyspnea is a warning sign of worsening heart failure, requiring immediate attention.
A nagging cough can be an early sign of heart failure and should be monitored for progression.
Monitoring weight is crucial for patients with heart failure as it indicates fluid volume overload.
Transcripts
hey everyone it's Sarah the registered
nurse rn.com and in this video I'm going
to talk about left-sided versus
right-sided heart failure so let's get
started to help you understand left
versus right-sided heart failure you
really have to visualize the anatomy of
the heart in your head and think about
what side is connected to what for
example the left side of your heart is
connected to your lungs so your
pulmonary circulation while your right
side of your heart is connected to the
venous circulation and with heart
failure what happens is that the heart
becomes extremely weak and it fails the
pump blood forward and instead that
blood is going to back up and fluid
volume overload is going to occur which
is why you start seeing these certain
signs and symptoms that tells you your
heart is failing so let's take a more
in-depth look at heart failure by
looking at right-sided heart failure the
right side of your heart receives
deoxygenated blood from the venous
system and whenever this side Fells the
pump blood the blood becomes extremely
congest tested on this side which will
actually go into the venous circulation
and this actually increases pressure in
the vena cava which normally brings used
blood hence deoxygenated blood back to
the heart for re-oxygenation by the
lungs and this built up pressure causes
the hepatic veins to become very
congested with blood which leads to
hepatomegaly and venous congestion where
you're going to see the venous
congestion in the large veins of the
neck like with jugular venous distention
which is referred to as jvd and you're
also going to see swelling in the
extremities like the legs and the feet
along with the abdomen which is known as
ascites and right-sided heart failure is
usually caused from left-sided heart
failure because of the increased fluid
pressure backing up from the left side
to the right and this will cause the
right side of the heart to become
overworked so whenever you're trying to
think of those signs and symptoms of a
patient with right-sided heart failure
remember that right-sided heart failure
presents with swelling and peripheral
signs and symptoms and to help you
remember those signs and symptoms let's
remember the word swelling so s is for
swelling in the legs the feet and
abdomen which again is known as ascites
W is for weight gain and weight gain is
one of those early signs that tells us
our patient is retaining fluid so
whenever a patient has heart failure you
definitely want to make sure that you're
doing daily weights on them at the same
time every day with the same scale and
that they're not gaining more than two
to three pounds in a day or five pounds
in a week if that is happening that is
an indication that okay this patient is
retaining fluid and we need to make sure
that their heart failure is not becoming
exacerbated e is for edema particularly
pitting edema and you will see this in
the lower extremities so whenever you
take your finger and you press in this
area and you remove your finger you will
actually see an indentation from where
you press and then L is for large neck
pains and that is that jugular venous
distention I was talking about earlier
that is just where that blood is backing
up and you're starting to see where it's
backing up and you will see the large
veins in the neck and then the other L
is for lethargic these patients will be
very weak and tired and it's because
their heart is weak and not able to
maintain proper cardiac output I is for
a regular heartbeat these patients are
at risk for atrial fibrillation so you
definitely want to monitor their Rhythm
make sure they're not entering into this
n is for nausea and this happens because
we have congestion of our liver and this
pressure is pushing on the abdomen
causing them not to really have an
appetite and really to feel sick at
their stomach and then G is for girth of
abdomen will be increased and this is
from the swelling of the liver and the
fluid building up in the abdomen which
can lead the patient not to be able to
breathe very well now let's talk about
left-sided heart failure so the left
side of your heart its goal is to pump
blood into arterial circulation because
it has fresh oxygenated blood it just
received to the lungs and it wants to
get it out to your body but with
left-sided heart failure what happens is
that heart is too weak on this side and
Blood starts to back up on this left
side and where it goes is into the lung
so the pulmonary circulation and it
congests it and this is actually the
most common type of heart failure and we
can further categorize left-sided heart
failure into either systolic or
diastolic heart failure so with systolic
this is heart failure with reduced
ejection fraction so we have left
ventricular systolic dysfunction and you
want to remember that systolic is the
contraction hence the squeezing phase of
the heart remember systolic starts with
an S squeezing starts with an S so this
is our squeezing part of the heart and
in systolic dysfunction there's an issue
with the left ventricle being able to
eject blood properly out of itself so
the or organs can't get all this Rich
oxygenated blood that it needs and
you're going to see that the patient
will have a low ejection fraction on
their echocardiogram now what is
ejection fraction well ejection fraction
is a calculation used to determine the
severity of heart failure a normal EF is
50 or greater meaning more than half of
the blood that fills the inside of the
ventricles is being pumped out and an EF
of 40 or less is a diagnosis for heart
failure and again the EF can be measured
with an echocardiogram a heart cath or a
nuclear stress test now with diastolic
heart failure this is where we have
heart failure with a preserved ejection
fraction so we have left ventricular
diastolic dysfunction and with this you
want to remember that diastole is the
filling or the resting phase of the harp
so when diastolic dysfunction The
ventricle is just too stiff to allow for
normal feeling of blood and since there
isn't an issue with contraction but the
actual feeling of that ventricle the
ejection fraction is actually going to
be normal hence preserved therefore as a
nurse you always want to make sure you
look in the diagnostic reports to see
what your patient's ejection fraction is
because it'll help give you a better
understanding about where your patient
is in heart failure so whenever we're
thinking about the signs and symptoms of
left-sided heart failure you want to
remember that it's going to present with
mainly pulmonary signs and symptoms and
these signs and symptoms are really
going to come from all that fluid that's
backing up in the patient's lungs
causing pulmonary edema so it's really
almost like they're drowning on their
own fluid so to help us remember those
signs and symptoms of left-sided heart
failure let's remember the mnemonic
drowning so D is for difficulty
breathing R is for rels which is also
known as crackles and this is an
abnormal sound that usually indicates
that your patient has pulmonary edema
and here's some sample audio of what
crackles may sound like
oh
next is O for orthopnia and this is
whenever the patient lies flat in the
Supine position they can't breathe they
start to smother so they have to set up
to breathe easier and this is really
stemming back from that pulmonary edema
that they're experiencing so it's more
helpful for the patient to be up in high
Fowler's position to breathe easier plus
you want to dangle their feet at that
bedside because what that's going to do
is it's going to decrease venous blood
return and help decrease that preload to
the heart then we have W which is for
weakness and again that just goes back
to because the patient has a weak heart
they're failing to maintain adequate
cardiac output so they really can't
tolerate a lot of activity instead
setting in bed is more restful for them
n is for nocturnal paroxysmal dysmia and
this is where they have these sudden
attacks while they're sleeping at night
where they wake up Suddenly feeling like
they can't breathe and many patients who
have heart failure actually have to
stack pillows together to set up at
night to breathe or they have to go to a
recliner to breathe at night so if your
patient tells you that this is happening
that is a warning sign that their heart
failure is getting worse I is for
increased heart rate so with this you
can see sinus tachycardia because what's
happening is you have the fluid volume
overload and this is really taxing the
heart out so as a last-ditch effort that
heart is going to increase its rate in
hopes of maintaining cardiac output but
in the end if this heart failure is not
treated with medications and other
things what can happen is that this
heart can completely fail and the
patient can go into cardiogenic shock n
is for nagging cough and this is one of
those things that could be an early sign
and symptom that the heart is getting
weak in a patient with heart failure so
you want to educate your patient to
watch out for this nagging dry hacking
cough that could be happening if it does
they want to report it so they can get
get treatment and then as a nurse what
you want to monitor for with this is
that that cough isn't becoming
productive where they're getting a
frothy foamy blood tinge cough to bat
that is a very bad sign and requires
immediate medical attention if you see
that and then lastly G for gaining
weight patients with heart failure again
as I pointed out before you want to
monitor their weight because weight is
an early indicator to us that hey fluid
volume overload is maybe presenting with
the patient okay so that wraps up this
video on left versus right sided heart
failure if you like to watch more videos
in this series you can access the link
in the YouTube description below
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