When can left heart failure lead to right heart failure?

[lichen]

When can left heart failure lead to right heart failure?

Working on a question that asked for the cause of symptoms fitting in with right heart failure. Answer was smoking. Other answer choices included atrial myxomas and rheumatic fever (perhaps leading to mitral valve regurg).

Could a myxoma or rheumatic fever ultimately lead to right heart failure?

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[NWwildcat2013]

I thought I read somewhere in UW last year that the most common cause of RH failure is LH failure.

 

[andrek82]

The most common cause of right heart failure is left heart failure. That's the mantra at least. Basically, anything causing increased pressures or impaired flow will eventually effect the upstream system. If you have left ventricular dysfunction, this will lead to left atrial dysfunction due to the need for increased diastolic filling pressures. Increased left atrial pressures lead to pulmonary hypertension (not the kind treated by phosphodiesterase inhibitors, to be clear), and this requires increased right ventricular pressure to achieve forward flow, etc. Anything which impairs left side fiction has a similar effect. These ideas apply throughout the vasculature. Pure pulmonary hypertension, pulmonary valve stenosis can lead to right heart failure. Right sided dysfunction leads to hepatic and renal dysfunction, etc.

 

[lichen]

The most common cause of right heart failure is left heart failure. That's the mantra at least. Basically, anything causing increased pressures or impaired flow will eventually effect the upstream system. If you have left ventricular dysfunction, this will lead to left atrial dysfunction due to the need for increased diastolic filling pressures. Increased left atrial pressures lead to pulmonary hypertension (not the kind treated by phosphodiesterase inhibitors, to be clear), and this requires increased right ventricular pressure to achieve forward flow, etc. Anything which impairs left side fiction has a similar effect. These ideas apply throughout the vasculature. Pure pulmonary hypertension, pulmonary valve stenosis can lead to right heart failure. Right sided dysfunction leads to hepatic and renal dysfunction, etc.

So if I come across questions like this, would time frame be a big consideration? As in a patient with left heart failure symptoms comes in a year later with right heart failure symptoms vs a patient that comes in with directly with right heart failure symptoms directly?

 

[andrek82]

Just in a broad sense, if you have a patient with symptoms of right heart failure (volume overload, not necessarily, though possible including orthopnea/PND), cause of left heart failure should be at the forefront of your mind. I am not sure what the question was asking that prompted you to ask your question, but in general I think there are only a couple ways that a root cause question can be asked. First, you may be asked to differentiate cor pulmonale from left heart failure. This would need clear symptoms that are either lung or left heart or both (which just means left heart as the cause). Second, you might have a question where they ask for risk factors for symptoms. That's a longer list, but the basic causes are pretty straightforward. Hypertension -> left heart failure, isolated pulmonary hypertension -> cor pulmonale, etc.

 

[sliceofbread136]

Smoking leading to cor pulm makes more sense and is more common than the other two choices you listed.