right-sided heart failure

右侧心力衰竭
  • 文章类型: Journal Article
    充血性肝病(CH),源于受损的肝静脉流量或升高的肝内压,代表心血管疾病如充血性心力衰竭(CHF)的重要后果。这篇文献综述概括了这种情况的核心方面,以肝脏充血为特征,细胞损伤,肝功能受损.由于反映原发性肝病的症状而出现诊断挑战。管理围绕解决根本原因和减轻液体潴留。这篇文献综述提供了CH的复杂性的快照,强调其临床意义和临床实践中全面理解的必要性。
    Congestive hepatopathy (CH), stemming from compromised hepatic venous flow or heightened intrahepatic pressure, represents a significant consequence of cardiovascular conditions like congestive heart failure (CHF). This review of literature encapsulates the core aspects of this condition, characterized by hepatic congestion, cellular injury, and impaired liver function. Diagnostic challenges arise due to symptoms mirroring primary liver diseases. Management revolves around addressing the underlying cause and mitigating fluid retention. This review of literature provides a snapshot of CH\'s complexity, emphasizing its clinical implications and the need for comprehensive understanding in clinical practice.
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  • 文章类型: Journal Article
    急性右心衰竭(RHF)是一种复杂的临床综合征,有广泛的临床表现,与死亡率和发病率增加相关,但这方面缺乏循证文献。临时右心室辅助装置(t-RVAD)是针对患有严重右心室功能障碍的选定患者的潜在治疗选择,可作为恢复的桥梁或永久性解决方案。我们试图进行系统评价以确定t-RVAD植入的安全性和有效性。31项研究符合纳入标准,从中提取数据。成功的t-RVAD断奶介于23%和100%之间。此外,临时RAVD植入后的30天生存率为46%至100%。出血,急性肾损伤,中风,装置故障是最常见的并发症.尽管如此,t-RVAD是严重RHF患者的救生选择,但证据来自使用各种设备的小型非随机异质性研究。RHF的病因和干预时间可能在确定t-RVAD结局中起主要作用。标准化端点定义,需要t-RVAD试验的设计和方法。此外,应继续努力改进技术,并及时提供t-RVAD。
    Acute right-sided heart failure (RHF) is a complex clinical syndrome, with a wide range of clinical presentations, associated with increased mortality and morbidity, but about which there is a scarcity of evidence-based literature. A temporary right-ventricular assist device (t-RVAD) is a potential treatment option for selected patients with severe right-ventricular dysfunction as a bridge-to-recovery or as a permanent solution. We sought to conduct a systematic review to determine the safety and efficacy of t-RVAD implantation. Thirty-one studies met the inclusion criteria, from which data were extracted. Successful t-RVAD weaning ranged between 23% and 100%. Moreover, 30-day survival post-temporary RAVD implantation ranged from 46% to 100%. Bleeding, acute kidney injury, stroke, and device malfunction were the most commonly reported complications. Notwithstanding this, t-RVAD is a lifesaving option for patients with severe RHF, but the evidence stems from small non-randomized heterogeneous studies utilizing a variety of devices. Both the etiology of RHF and time of intervention might play a major role in determining the t-RVAD outcome. Standardized endpoints definitions, design and methodology for t-RVAD trials is needed. Furthermore, efforts should continue in improving the technology as well as improving the timely provision of a t-RVAD.
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  • 文章类型: Journal Article
    The single most important factor in improving outcomes in right ventricular (RV) failure is anticipating and recognizing it. Once established, a vicious circle of systemic hypotension, and RV ischemia and dilation, occurs, leading to cardiogenic shock, multi-organ failure, and death. RV dysfunction and failure theoretically can occur in three settings-increase in the pre-load; increase in after load; and decrease in contractility. For patients deemed low risk for the development of RV failure, when it occurs, the correction of underlying cause is the most important and effective treatment strategy. Therapy of RV failure must focus on improving the RV coronary perfusion, lowering pulmonary vascular resistance, and optimizing the pre-load. Pre-load and after-load optimization, ventilator adjustments, and improving the contractility of RV by inotropes are the first line of therapy and should be initiated early to prevent multi-organ damage. Mechanical assist device implantation or circulatory support with extracorporeal membrane oxygenation (ECMO) may be needed in refractory cases.
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    文章类型: Case Reports
    肺毛细血管血管瘤病(PCH)是由肺毛细血管增生引起的病因不明的肺动脉高压(PH)的罕见原因。临床上,PCH见于性别倾向相同的年轻人,很少报道家族性倾向。PCH的主要临床表现是进行性呼吸困难,疲劳,咯血,心悸,以及后来的不可逆肺动脉高压和右心衰竭。特此,我们报告了三例PCH病例,每个病例都有一个独特的介绍,并有一个全面的文献综述,突出病因,临床表现,建立诊断的诊断方式和病理学,目前的治疗选择,和PCH的预后。总之,将PCH定义为PH的根本原因至关重要,因为大多数用于PH的药物在PCH中无效。由于肺水肿的风险增加,应避免使用血管扩张剂。肺的病理检查仍然被认为是最确定的诊断工具,然而它与并发症风险有关。高分辨率计算机断层扫描(HRCT)胸部目前被认为是诊断PH的基础非侵入性方式。到目前为止,没有明确的PCH治疗,排除肺移植,血管生成抑制剂有初步的有希望的结果。PCH预后极差,自诊断之日起中位生存期为3年。
    Pulmonary capillary hemangiomatosis (PCH) is a rare cause of pulmonary hypertension (PH) of unknown etiology resulting from pulmonary capillary proliferation. Clinically, PCH is seen in young adults with equal sex predilection and rarely reported familial predisposition. PCH\'s main clinical presentations are progressive dyspnea, fatigue, hemoptysis, palpitations, and later irreversible pulmonary hypertension and right-sided heart failure. Hereby, we report three PCH cases, each case presented with a peculiar presentation with a comprehensive literature review highlighting etiology, clinical presentations, diagnostic modalities and pathology in establishing a diagnosis, current treatment options, and prognosis of PCH. In conclusion, defining PCH as the underlying cause of PH is of utmost importance as most medications used for PH are ineffective in PCH. Vasodilators should be avoided due to the increased risk of pulmonary oedema. Pathological examination of the lung is still considered the most definitive diagnostic tool, yet it is associated with complications risk. High-Resolution Computed Tomography (HRCT) chest is currently considered the cornerstone non-invasive modality for the diagnosis of PH. So far, no definitive treatment of PCH excluding lung transplantation with preliminary promising results with angiogenesis Inhibitors. PCH carries a very poor prognosis with a median survival of 3 years from the time of diagnosis.
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  • 文章类型: Review
    镰刀,维生素C缺乏引起的疾病,是罕见的,特别是在高收入国家。镰刀病的症状通常表现为皮肤病,如伤口愈合不良和牙齿脱落,但通常不会有心脏受累。据报道,在一名患有自闭症谱系障碍的7岁男孩中,有一例可逆性肺动脉高压和右心衰。他的饮食非常有限,患有多关节痛,牙龈增生伴瘀斑,和疲劳。他的状况,包括肺动脉高压和右心衰竭,完全解决了补充维生素C。儿科医生应该对具有营养选择性的儿童有很高的怀疑,并意识到它可以表现为心脏症状。如果不治疗的话,镰刀可能会危及生命,但是补充维生素C可以迅速改善症状。
    Scurvy, a condition caused by vitamin C deficiency, is rare, especially in high-income countries. Symptoms of scurvy are typically characterised by dermatological disorders such as poor wound healing and tooth loss, but there is not usually cardiac involvement. A case of reversible pulmonary hypertension and right-sided heart failure owing to scurvy in a 7-year-old boy with autism spectrum disorder is reported. He had a very restricted diet and presented with polyarthralgia, gingival hyperplasia with ecchymosis, and fatigue. His condition, including pulmonary hypertension and right-sided heart failure, completely resolved with vitamin C supplementation. Paediatricians should have a high index of suspicion for scurvy in children with nutritional selectivity and be aware that it can manifest with cardiac symptoms. Scurvy may be life-threatening if not treated, but the symptoms can improve rapidly with vitamin C supplementation.
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  • 文章类型: Journal Article
    OBJECTIVE: Right-sided heart failure develops in lung transplantation candidates on prolonged peripheral extracorporeal membrane oxygenation support and is a major determinant of mortality. The use of central venoarterial extracorporeal membrane oxygenation for bridging of right-sided heart failure to lung transplantation was evaluated.
    METHODS: Retrospective case series and literature review.
    METHODS: A single tertiary care university hospital.
    METHODS: The study comprised lung transplantation candidates on extracorporeal membrane oxygenation bridging who developed right-sided heart failure.
    METHODS: Central venoarterial extracorporeal membrane oxygenation.
    RESULTS: Of 6 patients who underwent the study protocol, 3 were bridged successfully to lung transplantation and 1 was bridged to recovery.
    CONCLUSIONS: The study demonstrates that central extracorporeal membrane oxygenation may be a feasible option for bridging of right-sided heart failure to lung transplantation.
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