Heart failure occurs when the heart cannot pump effectively enough to sustain blood pressure to oxygenate the body. Right-sided heart failure usually results from left-sided heart failure. According to Donna D. Ignatavicius, MS RN, and M. Linda Workman, PhD, authors of the 2006 edition of "Medical-Surgical Nursing: Critical Thinking for Collaborative Care," over 5 million Americans live with heart failure. Treatment includes lifestyle modifications and medications such as diuretics and antihypertensives.
Diuretics
Right sided heart failure causes fluid retention. Patients experience swelling to the extremities and shortness of breath from a buildup of fluid in the lungs. Physicians prescribe medications called diuretics to remove excess fluid. Three categories of diuretics exist and each category works on a different part of the kidney to remove fluid. Loop diuretics such as furosemide remove salt and water but also deplete the electrolyte potassium. Other drugs used to treat congestive heart failure increase potassium loss so a potassium-sparing diuretic such as spironolactone may be selected. The third type of diuretics is thiazide diuretics which may be more suitable when patients need additional blood pressure control.
ACE Inhibitors
Medications for right-sided heart failure include the use of ACE inhibitors or angiotensin-converting enzyme inhibitors. ACE inhibitors such as lisinopril help control blood pressure without affecting cardiac output.
ARBs
Right-sided heart failure patients may take angiotensin-receptor blockers for blood pressure control when ACE inhibitors are not tolerated. Not first-line drugs, physicians use caution when prescribing ARBs to patients with congestive heart failure and taking diuretics.
Digoxin
Many heart failure patients take the cardiac glycoside digoxin. Digoxin slows down the heart rate and strengthens the contraction of the ventricles. This action increases the amount of blood pumped from the heart with each beat. Increased cardiac output helps decrease many symptoms associated with right-sided heart failure such as low blood pressure, fatigue and shortness of breath.
Dopamine
With right-sided heart failure, blood pressure can become so low a patient experiences shock. Dopamine stimulates the heart by increasing cardiac output and blood pressure, relieving shock. Dopamine also improves blood flow to the kidneys which helps the kidneys eliminate excess fluid. The effects of dopamine are dose dependent, with low doses affecting the kidneys and higher doses stimulating the heart.
Nitroglycerin
Nitroglycerin may be used in acute congestive heart failure to improve blood flow to the heart muscle. When patients are hypertensive, nitroglycerin can be used to lower blood pressure. However, nitroglycerin dilates blood vessels and can cause big drops in blood pressure, so cautious use in right-sided heart failure is recommended.
References
- "Medical-Surgical Nursing: Critical Thinking for Collaborative Care"; Donna D. Ignatavicius & M. Linda Workman; 2006
- MayoClinic.com: Heart Failure--Treatment and Drugs
- "Pearson Nurse's Drug Guide 2010"; Wilson, B. A., Shannon, T. M., & Shields, K. M.; 2010
