Managing Right Heart Failure:  Drugs, Drinks and Diet

Glenna L. Traiger, RN, MSN

PAH Clinical Nurse Specialist

Greater LA VA Medical Center/UCLA

Los Angeles, CA

Behavioral objectives:

1. Define right heart failure and list the common signs and symptoms.
2. Discuss medications used for the management of right heart failure.
3. Discuss the rationale for sodium and fluid restrictions and describe strategies to enable patients to incorporate these into their everyday lives.
4. Develop a patient education program for right heart failure self-management.

Outline:

I.                    Overview

a.       Basic heart anatomy and physiology

b.      Definition of right heart failure (RHF)

c.       Diagnosis and evaluation of RHF

                                                               i.      Signs and symptoms

                                                             ii.      Physical exam

                                                            iii.      Diagnostic tests

II.                 Drugs to manage RHF

a.       Digoxin

b.      Diuretics

                                                               i.      Loop diuretics

                                                             ii.      Thiazides diuretics

                                                            iii.      Aldosterone antagonists

                                                           iv.      Potassium replacement

III.               Drinks – Fluid management

a.       Daily weights

b.      Fluid restriction

c.       Adaptation strategies for patients

IV.              Diet – Sodium restriction

a.       Rationale

b.      Adaptation strategies for patients

                                                               i.      Nutrition labels

                                                             ii.      Making good choices

V.                 Summary

a.       Resources for patients

Self Assessment Questions

1.                  Common signs and symptoms of RHF include

a.       Jugular venous distention, peripheral edema, and fatigue.

b.      Hot, dry skin, low BP and thirst.

c.       Crackles or rales on auscultation, coughing up pink frothy sputum and orthopnea.

d.      Copious urine output, hypertension and arrhythmias.

2.                  All of the following diagnostic tests may be used to diagnose or monitor RHF EXCEPT

a.       BNP

b.      PFTs

c.       Echocardiogram

d.      Chest x-ray

3.                  Medications to treat RHF include digoxin for its positive inotropic effect and diuretics to prevent fluid retention.     

TRUE              FALSE

4.                  Self-care management for patients on fluid restrictions include all of the following EXCEPT

a.       Daily weights first thing in the morning.

b.      Call the PH center for weight gain of >2 lb/day or >5 lb/week.

c.       Monitoring amount of all fluid intake to keep below the prescribed amount.

d.      Finger stick serum potassium levels with each change in diuretic dose.

5.                  Sodium restriction is

a.       Easy for most patients to manage.

b.      Only used for left heart failure.

c.       Important to prevent fluid retention.

d.      Accomplished by switching to salt substitutes such as sea salt, garlic salt and soy sauce.