It is a condition characterized of the right ventricle of
propel blood forwards resulting in engorgement of right systemic venis with
enlargement of liver and oedema.
Causes:
1.Mitral steosis –commeonest casuse.
2.Sceondary to L.V.F.
3. Cor-pulmaonale due to-
a. Chronic bronchitis.
b.Emphysema.
4.Fallots tetra logy.
5. Left to right shunt e.g ASD, or VSD.
6. Pulmonary.
7.Cardiomypathy and serve anaemia.
Clinical features:
Symptoms-
1.Dyspoea and cough.
2. Weakness tiredness and anoxia.
3. Swelling of feet and abdomen.
4. Right upper abdominal discomfort due to tight capsule of
swollen liver.
5. Oliguria at day and polyuria at night.
6. Mental confusion in server cases.
Signs-
1.Dependent oedema e.g. of leg due to venous congestion.
2. Cold hand due to reduced peripheral blood flow.
3. Venous pressure high e.g engorged neck vein ascites.
4. Small Volume .
5.Sinus tachycardia may be present severe cases.
6. Hepato jugular reflux present.
7.Liver enlarged and tender.
8. Lung usually clear.
9.Splenoegally in prolonged congestion of liver.
10. On examination of heart.
a. Evidence of causes e.g pan systolic blowing, coarse or harsh systolic murmur of
tricuspid insufficiency, usually increased intensity during and just after
inspiration.
b. Gallop rhythm may be present.
Investigations:
1.X-ray chest Biventricular hypertrophy or only right
ventricular hypertrophy depending on cause.
2. E.C.G Right ventricular hypertrophy with right axis
deviation or biventricular hypertrophy may be present.
3. Echocardiography.
Management:
1.Rest in bed in propped up position.
2. Oxygen inhalation.
3. Diuretics frusemide may be given with potassium
supplement see above as in left heart failure.
4. Digitalization digitalis is used in selective cases, e.g
atrial fibrillation and atrial flutture.
5.Treament of precipitating disease i.e chronic bronchitis
with emphysema pulmonary infection anemia, myocardial infarction and onset of
arrhythmia.
Advice:
- Salt restricted diet.
- Avoide heavy physical work.
- Frusemide 40mg twice weekly with potassium supplement if required .
- If sputum is yellowish and excessive –give an appropriate antibiotic.
- Advice to attend a physician every 2 months interval.
