From the Guidelines
The correct statement about right heart failure is that a positive Kussmaul sign may be observed. This is based on the most recent and highest quality study available, which provides evidence-based guidance on the assessment and management of right-sided heart failure 1. Kussmaul sign refers to a paradoxical increase in jugular venous pressure (JVP) during inspiration, which occurs in right heart failure due to impaired right ventricular filling. This happens because the failing right ventricle cannot accommodate the increased venous return during inspiration, causing jugular distension rather than the normal decrease in JVP.
The other statements are incorrect:
- In right heart failure, the CVP waveform typically shows a prominent V wave (not flat), as the right ventricle is unable to accommodate the increased venous return, leading to increased pressure in the right atrium and a prominent V wave in the CVP waveform 1.
- Mitral valve regurgitation is associated with left heart failure (not right), as it is a condition that affects the left side of the heart, leading to increased pressure and volume overload in the left ventricle 1.
- Lower extremity edema in right heart failure is characteristically pitting (not non-pitting) due to fluid accumulation in the interstitial spaces, as the increased pressure in the right atrium and veins leads to fluid leakage into the interstitial spaces, resulting in pitting edema 1.
It is essential to note that right ventricular dysfunction is associated with poor clinical outcomes, including increased morbidity and mortality, and that early recognition and management of right heart failure are crucial to improve patient outcomes 1.
From the Research
Right Heart Failure Characteristics
- The statement "Positive Kussmaul Sign may be observed" is true, as Kussmaul's sign is associated with right ventricular myocardial infarction and right heart failure 2, 3.
- Kussmaul's sign is a paradoxical inspiratory rise in right atrial pressure, which can be an indicator of right ventricular dysfunction 2, 3.
- The presence of Kussmaul's sign is associated with adverse cardiopulmonary hemodynamics and poorer clinical outcomes in patients with heart failure 2, 4.
Clinical Assessment of Right Heart Failure
- Clinical assessment of the right heart, including evaluation of jugular venous pressure and Kussmaul's sign, can provide valuable information for risk assessment in patients with heart failure 5, 4.
- A high jugular venous pressure at rest or with inspiration is associated with a higher incidence of adverse outcomes in patients with heart failure 4.