Q&A: Right heart failure and pulmonary hypertension

Q: Can you please discuss right heart failure and its relationship to pulmonary hypertension instead of diastolic heart failure. For example, established diagnosis of heart failure and methamphetamine intoxication, established diagnosis of heart and smoke inhalation or carboxyhemoglobinemia, or established diagnosis of heart failure and. . . can you help me understand what other conditions we should be looking for?

A:  Right-sided heart failure can be due to several potential etiologies. The two most common are left-sided heart failure and chronic pulmonary lung disease.

When the left ventricle becomes weakened and/or stiff it cannot effectively pump blood to the body. This results in an increased pressure on the heart muscle due to congestion within the pulmonary circulation. Because the lungs and heart are connected, the resulting pressure pushes back into the right ventricle, causing the right ventricle to enlarge and ultimately causes right-sided heart failure.

The other potential underlying etiology is chronic lung disease. Two common examples are pulmonary fibrosis or chronic obstructive pulmonary disease. Using pulmonary fibrosis as the example, scar tissue affects the pulmonary arteries by compressing the vessels. The result is an increased pressure in the pulmonary vasculature which then extends into the right ventricle causing enlargement, and ultimately, right-sided heart failure.

Both cardiac and chronic pulmonary etiologies result in an enlarged right ventricle from pressure building up in the pulmonary arterial circulation which engorges or enlarges the right ventricle.  If left uncorrected, over time this will result in right sided heart failure or right ventricular failure. Because there is an increased pressure within the arterial pulmonary vasculature, this leads to pulmonary arterial hypertension (PAH).

Other possible etiologies for pulmonary arterial hypertension (PAH) can include coronary heart disease, idiopathic pulmonary arterial hypertension, liver diseases such as cirrhosis, various auto-immune diseases such as scleroderma or lupus, HIV, illicit drug use such as methamphetamines, certain prescription diet medications, connective tissue diseases and congenital disorders.

Editor’s Note: Dawn Valdez, RN, LNC, CDIP, CCDS, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at dvaldez@hcpro.com. For information regarding CDI Boot Camps, click here.