Heart Failure: The Right Heart, Kidneys, & Treatments

Heart Failure: The Right Heart, Kidneys, & Treatments
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  • 0:01 Heart Failure
  • 0:44 Right-Sided Heart Failure
  • 3:32 How the Kidneys Play a Role
  • 6:23 Tachycardia in Heart Failure
  • 9:38 Lesson Summary
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Lesson Transcript
Instructor: Artem Cheprasov
In the second of two lessons on heart failure, we will discuss the signs of right-sided heart failure, fast heart rates, the important role the kidneys play in heart failure, and the major treatment options for this condition.

Heart Failure

If you're tuning into this lesson, you've hopefully already read or watched the first part of our exploration of heart failure, a condition where the heart doesn't pump enough blood into circulation. In that lesson, we focused on left-sided heart failure, which results in some pretty unfortunate problems, most notably, lots of problems breathing.

Of course, the problems associated with left-sided heart failure are only half the story, and in this lesson, you'll find out how many other troubling things can occur in your heart and how your own body actually tries to finish you off during heart failure.

Right-Sided Heart Failure

Right-sided heart failure can occur alone or as a consequence of left-sided heart failure (due to something like hypertension). If the lung vessels are overfilled with blood during left-sided heart failure, it means that there's barely any room left for the right ventricle to pump blood into the lungs.

The only way the right ventricle can move blood forward into the lungs is by straining really hard against the force of all that blood in the pulmonary vessels. The right ventricle, by nature, is already much weaker than the left ventricle, since it normally doesn't have to pump nearly as hard against pulmonary circulation as the left ventricle pumps blood against systemic - or body-wide - circulation. This means the right side of the heart can fail as a result of left-sided heart failure.

When the right heart fails, blood cannot move forward into the lungs very well. Go ahead and try to fill a full bucket of water, with even more water. It's just going to spill out of the bucket just like blood backs up out of the heart in the case of right heart failure.

In real life, this means blood gets backed up in the right atrium and then in the venous circulation normally sending blood to the right side of the heart. If the venous circulation is overfilled with blood due to this backup, then it stretches and distends like a balloon stretches and distends when filled with water. The pressure increases as well for all the same reasons. This leads to:

  • Increased jugular venous pressure and jugular venous distension. The jugular veins just get really big as a result of all that backed-up blood.
  • Hepatic congestion will occur for the same reason.
  • Ascites, fluid accumulation in the abdomen, which causes swelling of the abdomen.
  • Peripheral edema, fluid accumulation and swelling - usually in the ankles and legs will occur as well.

The latter two occur for the same reasons pulmonary edema occurs when there is left-sided heart failure. The veins are trying to relieve themselves of excess fluid by sending it to the empty spaces in your abdomen and the empty spaces between the tissues of your body in general. Particularly, the excess fluid in the legs can lead to pitting edema, where there's so much fluid that you can actually leave a finger mark when you press down upon it.

How the Kidneys Play a Role

Unfortunately, that's not all there is to heart failure. I always like to harp on the fact that the heart isn't just alone or only connected to the lungs. Just by the information I've already presented, you can see how heart failure impacts the liver that's sending venous blood to the heart. The heart also affects other organs, namely the kidneys.

Your kidneys are super critical in making sure your body maintains appropriate water balance. The kidneys are the guys that either excrete excess water, or instead, hold it back in the body during episodes of things like dehydration.

Now, stop and think about something for me. If the lungs, veins, liver and so forth are congested with a lot of blood due to heart failure, then the kidneys should logically excrete as much fluid out of the body as possible to decrease the congestion. But logic is many times very much absent from physiological systems. In heart failure, the kidneys actually preserve water within the body! They're trying to kill you!

Remember, during heart failure, the heart is malfunctioning. It cannot pump enough blood out into the arterial circulation. I don't care if you have too little, too much, or normal amounts of fluid in the body. The heart can't pump any of it forward, in any adequate amount. That's the definition of heart failure. Period!

Because of this, the kidneys do not receive appropriate blood flow to them. Decreased blood flow to the kidneys tricks them into believing that the body is dehydrated, even when there may be too much fluid backed up in pulmonary and venous circulation. The kidneys activate a water-conserving, blood pressure-raising system called the renin-angiotensin-aldosterone system (RAAS).

The RAAS increases blood pressure and volume in situations when the kidneys believe (erroneously or not) a dangerous condition known as hypovolemia, or low blood volume, is occurring.

Let's stop again. Think through this with me. If the lungs and veins are already congested with too much volume and if you know that high blood pressure (or hypertension) leads to heart failure, then is increasing blood pressure by constricting blood vessels and increasing blood volume an appropriate response by the body to heart failure? Of course not! It only exacerbates the stress and strain upon a failing heart and worsens a person's signs and symptoms of heart failure.

Tachycardia in Heart Failure

One important sign of heart failure I haven't had time to mention before is tachycardia, an abnormally fast heart rate. The reason the heart beats so fast in heart failure should be clear by now. If the body isn't getting enough oxygen as a result of impaired oxygenation in the congested lungs and improper forward flow of blood due to a weak heart, then the tissues and organs of your body signal to the heart to hurry it up! Hurry up with the blood flow, that is. They need oxygen to live and pronto.

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