Case discussion on Right heart failure with pulmonary artery hypertension
Details of the patient are present in following link:
And my analysis for the case is in the following leak:
Active learning points from this case:
[31/05/20, 8:50:29 AM] Student14:
How does Right Ventricle fails in pulmonary artery hypertension?
[31/05/20, 8:54:51 AM] Student4: In pulmonary artery hypertension there is increased afterload to the right ventricle
[31/05/20, 9:04:04 AM] Post Residency PG1: What is afterload vs pre-load and what is their significance in the management of heart failure?
[31/05/20, 9:06:35 AM] Student4: Afterload is resistance against which ventricle has to pump and preload is amount of ventricular stretch
[31/05/20, 9:04:44 AM] Student9: *The heart needs to work harder to force the blood through the vessels against this pressure. Over time, this causes the right side of the heart to become larger. This condition is called right-sided heart failure, or cor pulmonale.
[31/05/20, 9:09:27 AM] Post Residency PG1: Cor pulmonale may not have failure. What is the exact definition of cor pulmonale?
[31/05/20, 9:13:25 AM] Student12: Cor pulmonale occurs when the blood pressure in the pulmonary artery—which carries blood from the heart to the lungs—increases and leads to the enlargement and subsequent failure of the right side of the heart.
[31/05/20, 9:18:40 AM] Student7: Cor pulmonale is the right heart failure when there is primary lung disorder?
[31/05/20, 9:18:48 AM] Post Residency PG1: Why is it called cor pulmonale?
[31/05/20, 9:19:25 AM] Post Residency PG1: Does it always have to have failure? What is the exact definition?
[31/05/20, 9:22:55 AM] Student9: COR PULMONALE
DEFINITION
Cor pulmonale, often referred to as pulmonary heart disease. is defined as dilation and hypertrophy of the right ventricle in response to diseases of the pulmonary vasculature and/or lung parenchyma. Historically, this definition has excluded congenital heart disease and those diseases in which the right heart fails secondary to dysfunction of the left side of the heart.
[31/05/20, 9:26:36 AM] Post Residency PG1: Why is pre-load reduction an often used strategy in heart failure other than afterload reduction?
[31/05/20, 9:27:50 AM] Post Residency PG1: Good. Please always share the reference link to anything that you share that are not your original thoughts.
See the important thing here is dilatation and not failure?
[31/05/20, 9:30:17 AM] Student9: Harrison's tb
18th edition pg no 1913
[31/05/20, 9:06:40 AM] Student14: Why right ventricle only affected ?
[31/05/20, 9:10:08 AM] Post Residency PG1: Answer this someone
[31/05/20, 9:10:54 AM] Post Residency PG1: To put it in another way when will the left ventricle similarly get affected?
[31/05/20, 9:11:28 AM] Student4: When there is systemic hypertension
[31/05/20, 9:12:03 AM] Student9: Structural integrity of right ventricle
[31/05/20, 9:13:01 AM] Student15: Aortic stenosis
[31/05/20, 9:13:24 AM] Student14: Yes...Right Ventricle is thinwalled
[31/05/20, 9:17:53 AM] Post Residency PG1:
student9 now can you answer student14 question again by looking atstudent4 answer?
[31/05/20, 9:13:29 AM] Student4: When there is rt ventricular failure ,preload to the left ventricle decreases this can lead to left ventricular failure also
[31/05/20, 9:20:48 AM] Post Residency PG1: Does reduced pre-load cause failure or it's a strategy to treat failure?
[31/05/20, 9:22:25 AM] Student4: Reduced preload can lead to decrease in cardiac output
[31/05/20, 9:30:47 AM] Student12: Preload reduction results in decreased pulmonary capillary hydrostatic pressure and reduction of fluid transudation into the pulmonary interstitium and alveoli.
[31/05/20, 9:33:07 AM] Student13: In heart failure, preload is already elevated due to ventricular dilation and/or increased blood volume. Hence preload reduction will not exacerbate pulmonary or systemic congestion and edema.
[31/05/20, 9:36:36 AM] Post Residency PG1: How? Please elaborate
[31/05/20, 10:12:28 AM] Student12: decreasing preload leads to a reduction in ventricular wall stress by decreasing the size of the heart. Reducing venous pressure decreases proximal capillary hydrostatic pressure, which reduces capillary fluid filtration and edema formation
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