What are the clinical manifestations of right heart failure

Common clinical manifestations of right heart failure include dyspnea and paroxysmal nocturnal dyspnea in different aspects, as well as intestinal symptoms such as loss of appetite, abdominal distension, nausea, vomiting and other problems.

(1) Gastrointestinal symptoms: Long-term gastrointestinal congestion can cause loss of appetite, abdominal distension, nausea, vomiting, constipation and upper abdominal pain.

(2) Kidney symptoms: Renal congestion causes decreased renal function, less urine during the day, and more urine at night. There may be a small amount of proteinuria, a few hyaline or granular casts, and red blood cells. Blood urea nitrogen may be elevated.

(3) Pain in the liver area: The liver is congested and swollen, the liver capsule is expanded, the right upper abdomen is bloated and uncomfortable, and there is pain in the liver area. In severe cases, severe pain may occur and may be misdiagnosed as acute abdomen and other diseases. Chronic heart failure with long-term hepatic congestion may lead to cardiogenic cirrhosis.

(4) Dyspnea: In isolated right heart failure, pulmonary congestion is usually not present and shortness of breath is not as obvious as in left heart failure. When right heart failure occurs on the basis of left heart failure or mitral stenosis, dyspnea is alleviated compared to left heart failure because pulmonary congestion is reduced.

Left heart failure

(1) Dyspnea: Dyspnea is an early and major symptom of left heart failure.

1) Exertional dyspnea: Dyspnea initially occurs only during heavy physical activity and resolves on its own during rest. The main difference between exertional dyspnea in normal people and patients with heart failure is that the latter also experience increased dyspnea during normal-level activities. As left ventricular dysfunction worsens, the intensity of exertion that causes dyspnea gradually decreases.

2) Paroxysmal nocturnal dyspnea: Paroxysmal dyspnea often occurs at night. The patient suddenly wakes up, feels a severe sense of suffocation and terror, and quickly sits up, which takes 30 minutes or more to be relieved. It is usually accompanied by wheezing in both lungs, which is called cardiac asthma. The possible mechanism of its occurrence is related to the reabsorption of interstitial fluid and increased venous return after bed rest, increased vagus nerve tension during sleep causing small bronchi spasm, and elevation of the diaphragm and reduced vital capacity when lying down.