Causes of congestive heart failure

The article was professionally consulted with Master, Doctor Nguyen Minh Son - Interventional Cardiologist - Department of Medical Examination & Internal Medicine - Vinmec Nha Trang International General Hospital.

Bronchiectasis is secondary right ventricular dilatation and hypertrophy. The cause of the disease is due to increased pulmonary artery pressure causing damage to lung function or structure.

Bronchiectasis is the result of diseases of the respiratory system and associated vascular structures; is not caused by right-sided heart failure secondary to left-sided heart failure, congenital heart disease, or acquired valvular disease. Congestive heart failure is usually a chronic condition, but can also be acute.
Respiratory pathology causes pulmonary hypertension by some of the following mechanisms:
Injury to the capillary bed Vasoconstriction due to lack of oxygen concentration, increased CO2 concentration in the blood, or both; Causes increased alveolar pressure (eg, in chronic obstructive pulmonary disease, due to mechanical ventilation); Causes strong mediastinal hyperplasia (in response to pulmonary arterial hypertension due to other mechanisms). Pulmonary hypertension increases right ventricular afterload, leading to a series of events similar to left heart failure, including elevations in end-diastolic pressure, central venous pressure, hypertrophy and ventricular dilatation. In addition, hyperviscosity due to polycythemia vera secondary to chronic hypoxia may force the right ventricle to work harder. In rare cases, it is possible that right heart failure will affect the left ventricle, because the interventricular septum is pushed to the left, affecting the filling phase and thereby causing a decline in diastolic function. .

Normally, the right ventricle of the heart performs the process of contracting and ejecting blood into the pulmonary artery, in the lungs will continue to provide more oxygen to the blood, so that the blood circulates to nourish all tissues and organs in the body. However, in lung injury or disease, when the pressure inside the pulmonary artery increases, it means that the heart must create a greater pressure to overcome the pulmonary artery pressure in order to push. blood into the pulmonary artery.
Therefore, after a period of time when the heart has to work too hard, patients with related lung diseases are very likely to have right-sided heart failure, or suffer from congestive heart failure. Diseases and lesions in the lungs that can cause pulmonary artery pressure to rise, the most common are:
COPD - chronic obstructive pulmonary disease: This is also the main cause of most patients with cor pulmonale. chronic, and frequent exacerbations or respiratory infections. Causes right ventricular overload, increases the risk of pulmonary embolism, increases in cor pulmonale; Loss of lung tissue due to trauma or surgery; Chronic and untreated pulmonary embolism; Pathology causing pulmonary embolism; Generalized scleroderma; Interstitial lung disease ; Kyphoscoliosis; Obesity with alveolar hypoventilation; Neuromuscular diseases of the respiratory muscles; Primary alveolar hypotension.

Symptoms of chronic heart disease depend on the stage of the disease. Specifically:
Early stage: Typical symptoms of chronic obstructive pulmonary disease include coughing, sputum production, shortness of breath. Symptoms of restrictive lung disease such as fibrous TB, thoracic malformation, pulmonary fibrosis, due to pneumonectomy; Pulmonary hypertension phase: Dyspnea on exertion is always present. Cough, sputum can cough up blood. Cupped nails; Stage of right ventricular failure: Dyspnea gradually increases with exertion; coronary angina due to right ventricular ischemia or dilated pulmonary artery; liver pain, hepatomegaly; leg edema, concave soft edema, whole body edema, sometimes ascites; purple is the late sign, purple lips, sometimes purple black; bulging and red eyes due to increased synaptic vasculature such as frog eyes; drumstick finger; Oliguria, tachycardia, possible complete arrhythmia. Physical symptoms of cor pulmonale:
Rale crackles or wheezing are symptoms of underlying lung disease. T2 splits with strong P2 in the early stages. Systolic murmur with click in the hepatopulmonary region in the severe phase with diastolic murmur due to pulmonary valve regurgitation. In addition, T3, T4, and systolic murmurs of tricuspid regurgitation can be heard. Percussion echoes in the lungs when COPD is an underlying disease, ascites in more severe stages.

Chest X-ray:
Chest X-ray image shows signs of central pulmonary arteries and decreased peripheral pulmonary circulation. Pulmonary hypertension should be suspected when the right descending pulmonary artery is >16mm and the left pulmonary artery is >18mm; Right ventricular megaloblastic sign; These signs are less sensitive to kyphosis or overinflated lungs. Echocardiography:
2D echocardiogram showing signs of chronic right ventricular pressure overload (right ventricular wall thickening, paradoxical interventricular septum); Doppler ultrasound estimates pulmonary artery pressure. Other tests:
X-ray – ventilation/perfusion lung; Pulmonary angiography; Chest CT scan; Cardiac MRI; Radiograph with nuclear radiation. Electrocardiogram:
Right axis deviation; R/S > 1 in V1; R/S < 1 in V6; P waste; S1 - Q3 - T3 and complete or incomplete right bundle branch block, especially if pulmonary embolism is present; Low QRS amplitude; Severe right ventricular hypertrophy, manifested by Q waves in the prethoracic leads, may be confused with myocardial infarction; Types of arrhythmias. Blood tests:
Arterial blood gases: evaluate oxygen status and acid-base disturbances Blood tests for BNP levels show that elevation alone is not sufficient to diagnose cor pulmonale; Has diagnostic value when combined with other noninvasive tests in a reasonable clinical setting. Hematocrit for polycythemia vera (may be a consequence of underlying disease but may also be a factor for increased pulmonary artery pressure due to increased blood viscosity) Alpha 1 – antitrypsin Antinuclear antibody concentration ANA Hypercoagulable state: protein S, protein C, antithrombin III, factor V Leyden, anticardiolipin antibodies, homocysteine.

When suffering from congestive heart failure, the patient should do light work, not exertion. When the body shows signs of right heart failure, rest, do not work and have a light diet.
The treatment of bronchiectasis will depend on the cause of the disease, specifically:
Diagnosis and treatment of chronic obstructive pulmonary diseases, pulmonary fibrosis, bronchiectasis, bronchial asthma... Blood oxygen method with the goal of maintaining SaO2 concentration in the range of 90-92%, pH: 7.36-7.42 (if measured), PaCO2: 40-45 mmHg. Diuretics Extraction: Specify hematocrit > 60%, take about 300 ml each time. When there is an episode of superinfection: Patients who are prescribed antibiotics for bronchiectasis due to lung diseases with obstructive ventilation disorders should use more inhaled corticosteroids and bronchodilators. Breathing exercises: Increases lung and thoracic expansion, alveolar ventilation, especially diaphragmatic breathing. Do not smoke pipe, tobacco, avoid smoke, industrial dust... In addition, it is also necessary to find and treat the cause of congestive heart failure. In summary, bronchiectasis is a consequence of diseases of the respiratory system and associated vascular structures. Treatment will depend on the cause. Therefore, if there are symptoms such as a lot of cough, sputum, shortness of breath with exertion or swelling, the patient should go to a medical facility for examination and appropriate treatment.
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