Left-Sided Heart Failure vs Right-Sided Heart Failure Pathophysiology Nursing NCLEX Review

Summary

In 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

00:00

💓 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.

05:02

🔍 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.

Keywords

💡Heart Failure

Heart failure is a chronic condition where the heart is unable to pump blood effectively, leading to a reduced blood supply to the body and an accumulation of fluid in the lungs and other organs. In the video, heart failure is the central theme, with a distinction made between left-sided and right-sided heart failure, each presenting different symptoms and consequences.

💡Anatomy of the Heart

The anatomy of the heart refers to the structure and arrangement of its parts. In the script, understanding the heart's anatomy is crucial for distinguishing between left-sided and right-sided heart failure, as the left side is connected to the lungs for oxygenation, while the right side is connected to the body's venous system.

💡Pulmonary Circulation

Pulmonary circulation is the pathway through which deoxygenated blood travels from the heart to the lungs to receive oxygen. The script mentions that the left side of the heart is connected to the pulmonary circulation, which is affected in left-sided heart failure, leading to congestion in the lungs.

💡Venous Circulation

Venous circulation is the part of the circulatory system that carries blood toward the heart. The right side of the heart is connected to this system, as explained in the video, and right-sided heart failure results in congestion in the veins, leading to symptoms like hepatomegaly and peripheral edema.

💡Fluid Volume Overload

Fluid volume overload occurs when the body retains excess fluid, which can be a result of heart failure. The video script describes how heart failure leads to blood backing up, causing fluid volume overload and the appearance of symptoms such as swelling and edema.

💡Right-Sided Heart Failure

Right-sided heart failure is a condition where the right side of the heart cannot effectively pump blood to the lungs. The script explains that this can cause symptoms like jugular venous distention (JVD), swelling in the extremities, and ascites, and is often a result of left-sided heart failure.

💡Systolic Heart Failure

Systolic heart failure, also known as left ventricular systolic dysfunction, is characterized by a reduced ejection fraction, indicating that the heart is not effectively pumping blood out of the ventricle. The script uses the mnemonic 'systolic' starting with 'S' for squeezing to illustrate this concept.

💡Diastolic Heart Failure

Diastolic heart failure, or left ventricular diastolic dysfunction, occurs when the heart's ability to relax and fill with blood is compromised, despite normal ejection fraction. The script explains that diastolic dysfunction can make the ventricle too stiff to allow for normal filling.

💡Ejection Fraction

Ejection fraction is a measure of how well the heart's left ventricle is pumping blood. A normal ejection fraction is 50% or higher, while an EF of 40% or less can indicate heart failure. The video script discusses the importance of ejection fraction in diagnosing and understanding the severity of heart failure.

💡Pulmonary Edema

Pulmonary edema is the buildup of fluid in the lungs, which can occur as a result of heart failure. The script describes how left-sided heart failure leads to blood backing up into the lungs, causing pulmonary edema and symptoms such as orthopnea and crackles.

💡Cardiogenic Shock

Cardiogenic shock is a life-threatening condition where the heart fails to pump enough blood to meet the body's needs. The video script mentions this as a possible outcome if heart failure is not treated, highlighting the severity of untreated heart conditions.

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