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Introduction
- Right heart failure is the inability of the right ventricle to generate enough stroke volume for forward flow, resulting in venous congestion, under filling of the left ventricle and in the most advanced cases, cardiogenic shock. This acute and chronic condition can be caused by right ventricular infarction, pulmonary hypertension, pulmonary embolism, left ventricular dysfunction or sepsis.
Clinical Presentation
- Vital signs may reveal hypotension and/or hypoxia
- Increased heart rate in compensation bid for the fall in cardiac output
- Distended jugular (neck) veins
- Cyanosis (central and/or peripheral)
- Swelling of ankles, lower legs and sacral area
- Nodal or complete AV block as an infarction result
- If severe failure, may also present with lethargy and/or dyspnoea
- Severe heart failure may present as cardiogenic shock
Exclusion Criteria
Exclusion Criteria
Risk Assessment
- Hypotension should be treated with considered fluid loading
- Avoid GTN (or other nitrates) as this can lessen preload and exacerbate symptoms
Management
Primary Care
- Primary Survey
- Ensure patient is positioned sitting or semi-recumbent (BP permitting), preferably with legs hanging down
- Do NOT walk the patient
- Open, clear and maintain the airway
- Full Vital Signs Survey, particularly GCS, BGL and
Pulse Oximetry
- Administer oxygen with assisted ventilation if required
- Repeat vital signs every 10 minutes (5 minutes if patient appears time critical)
Intermediate Care (EMT / Level 2)
- Apply cardiac monitor if trained and authorised.
- If IV in situ, maintenance fluid TKVO only.
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
- Apply cardiac monitor; manage Acute Coronary Syndrome if indicated
- Establish vascular access
- Consider obtaining pre-hospital blood sample
- Consider fluid therapy
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
Critical & Extended Care (CCP, PSO)
- As per Advanced Care (AP) guidelines
Additional Information
- Mental confusion may occur due to hypoxia.
- Ensure oxygen is administered as per the Medication Protocol, even if the patient tries to reject it; rejection may be due to hypoxia.
- Do not use GTN in CCF as it may over-stimulate a failing heart.
References
References
Document Control
Directorate
Clinical Services
Responsible Manager
Head of Clinical Services
Published Date
Review Date
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