We applaud the excellent review on the investigation and management
of congestive heart failure.1 However its noticeable that whilst the
focus of the article was on congestive heart failure, the emphasis was
predominantly on left ventricular failure. The possibility of isolated
right ventricular failure (RVF) was not highlighted.
It is important to recognize that isolated RVF and Pulmonary Hypertension
can present as a medical emergency. In many patients diagnosis is delayed
as signs and symptoms are confused with biventricular or left ventricular
failure and there is delay in initiating appropriate management.
Tricuspid regurgitation which is often a significant component of this
pathology may be ‘silent’ as the murmur may not be clinically audible and
hence early availability of echocardiography cannot be over emphasized.
In RVF loop diuretics are the first line treatment, while there is no
clear evidence for the benefit of angiotensin converting enzyme inhibitors
or beta blockers which are essential for optimum management of left
ventricular failure.
There is a plethora of literature on the diagnosis and treatment of
predominantly left ventricular failure or biventricular failure but
isolated right ventricular failure though not uncommon in clinical
practice, has not received its due recognition.
Rapid Response:
Treatment of Right sided Heart Failure
We applaud the excellent review on the investigation and management
of congestive heart failure.1 However its noticeable that whilst the
focus of the article was on congestive heart failure, the emphasis was
predominantly on left ventricular failure. The possibility of isolated
right ventricular failure (RVF) was not highlighted.
It is important to recognize that isolated RVF and Pulmonary Hypertension
can present as a medical emergency. In many patients diagnosis is delayed
as signs and symptoms are confused with biventricular or left ventricular
failure and there is delay in initiating appropriate management.
Tricuspid regurgitation which is often a significant component of this
pathology may be ‘silent’ as the murmur may not be clinically audible and
hence early availability of echocardiography cannot be over emphasized.
In RVF loop diuretics are the first line treatment, while there is no
clear evidence for the benefit of angiotensin converting enzyme inhibitors
or beta blockers which are essential for optimum management of left
ventricular failure.
There is a plethora of literature on the diagnosis and treatment of
predominantly left ventricular failure or biventricular failure but
isolated right ventricular failure though not uncommon in clinical
practice, has not received its due recognition.
Dr Ifedolapo Oluwole, MRCP
SPR Elderly Care
Competing interests:
None declared
Competing interests: No competing interests