In left-sided heart failure, the left ventricle fails to pump blood effectively, leading to a backup of blood in the lungs. This causes pulmonary congestion and other related symptoms. Key priority assessment findings include:
- Dyspnea (Shortness of Breath): Often worse with exertion or when lying flat (orthopnea), and may progress to paroxysmal nocturnal dyspnea (sudden shortness of breath during the night).
- Pulmonary Crackles: Fine crackling sounds heard on auscultation, indicating fluid accumulation in the alveoli.
- Cough: Often dry and persistent, but may produce frothy or blood-tinged sputum in severe cases.
- Fatigue and Weakness: Resulting from reduced cardiac output and decreased oxygen supply to tissues.
- Tachycardia: The heart compensates for decreased output by increasing the heart rate.
- Cyanosis: Bluish discoloration of the skin, particularly the extremities, due to inadequate oxygenation.
Right-Sided Heart Failure:
Right-sided heart failure typically occurs as a consequence of left-sided heart failure but can also result from conditions like pulmonary hypertension or chronic lung disease. In right-sided heart failure, the right ventricle is unable to pump blood effectively into the pulmonary arteries, leading to systemic congestion. Key assessment findings include:
- Peripheral Edema: Swelling of the feet, ankles, and legs due to fluid accumulation.
- Jugular Venous Distension (JVD): Increased pressure in the jugular veins, visible when the patient is at a 45-degree angle.
- Hepatomegaly: Enlargement of the liver due to congestion of blood flow, often leading to right upper quadrant abdominal pain.
- Ascites: Accumulation of fluid in the abdominal cavity, causing distension.
- Weight Gain: Rapid weight gain due to fluid retention.
- Nocturia: Increased urination at night as fluid is reabsorbed when lying down.
Differences:
- Left-sided heart failure primarily affects the lungs, leading to pulmonary congestion and respiratory symptoms.
- Right-sided heart failure primarily affects the systemic circulation, leading to peripheral edema, hepatomegaly, and other signs of systemic congestion.