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Related Concept Videos

Heart Failure III: Clinical Manifestations01:26

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Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
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Lymphatic vessels, known as lymphatics, are crucial in transporting lymph from peripheral tissues to our venous system. This process begins with lymph entering through tiny capillaries that branch through tissues. These capillaries have unique features such as larger diameters, thinner walls, and a distinctive one-way valve system formed by overlapping endothelial cells.
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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
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Related Experiment Video

Updated: Aug 5, 2025

A Large Animal Model for Pulmonary Hypertension and Right Ventricular Failure: Left Pulmonary Artery Ligation and Progressive Main Pulmonary Artery Banding in Sheep
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Ascites in Animals With Right Heart Failure: Correlation With Lymphatic Dysfunction.

Yoav Dori1,2, Jeremy Mazurek3, Edo Birati4

  • 1Jill and Mark Fishman Center for Lymphatic Disorders Children's Hospital of Philadelphia Philadelphia PA.

Journal of the American Heart Association
|March 28, 2023
PubMed
Summary

Fluid overload in right heart failure is linked to lymphatic system changes, not just cardiovascular issues. This study highlights lymphatic dysfunction as a key factor in ascites development.

Keywords:
ascitesedemaheart failurelymphaticsthoracic duct

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Area of Science:

  • Cardiovascular Science
  • Lymphatic Physiology
  • Gastroenterology

Background:

  • Congestive heart failure (CHF) is a major global health concern, leading to significant morbidity and mortality.
  • Fluid overload, manifesting as pulmonary edema, peripheral edema, and ascites, is a common complication of CHF.
  • The precise causes of fluid overload and the role of lymphatic circulation abnormalities remain incompletely understood.

Purpose of the Study:

  • To investigate the role of lymphatic system dysfunction in the development of ascites in a large animal model of right heart failure.
  • To compare cardiovascular and lymphatic findings between animals with and without ascites secondary to severe tricuspid regurgitation.

Main Methods:

  • A study involving thirteen Yorkshire pigs with induced right heart failure due to severe tricuspid regurgitation.
  • Animals were divided into two groups: those who developed ascites (Group 2) and those who did not (Group 1).
  • Hemodynamic parameters, liver size, and lymphatic system function (thoracic duct flow and diameter) were assessed and compared between groups.

Main Results:

  • No significant differences were observed in hemodynamic parameters, including central venous pressure, between the ascites and non-ascites groups.
  • Animals with ascites exhibited significantly larger liver size (63.3±14.0 mL/kg vs. 30.3±12.4 mL/kg; P=0.001).
  • Regurgitant thoracic duct flow was significantly more prevalent (86% vs. 17%; P=0.029), and minimal thoracic duct diameter was larger (4.2±2.2 mm vs. 2.3±0.3 mm; P=0.035) in the ascites group.

Conclusions:

  • Fluid overload in right heart failure, in this model, correlated with lymphatic system abnormalities rather than hemodynamic parameters.
  • Lymphatic dysfunction, including regurgitant flow and altered thoracic duct diameter, appears to play a significant role in ascites formation.
  • These findings suggest that lymphatic system dysfunction, not solely cardiovascular function, is critical in the pathophysiology of fluid overload in right heart failure.