Right-sided heart failure develops when the right side of the heart no longer pumps the blood as well as it should be, causing the blood to accumulate back into the vein system and limiting the amount of blood that the heart can pump per minute.1 The symptoms of right-sided heart failure, such as dyspnea (shortness of breath), edema (swelling of the limbs), and fatigue, can be severe. There are a variety of reasons why the right side of the heart can become weak. Therefore, the treatment, which may include lifestyle changes and medications, is determined on the basis of the cause.
Anatomy of the Heart
The heart is made up of four chambers. The upper chambers are called the left and right atria, and the lower chambers are called the left and right ventricles. A wall of muscle called the septum separates the left and right atria and the left and right ventricles.
The symptoms of right-sided heart failure are not dissimilar to those of left-sided heart failure, but they can be more severe:
- Shortness of breath (dyspnea), even after only a small amount of effort
- Weakness and lethargy
- Swelling (edema), which often affects not only the ankles and lower extremities but also the thighs, abdomen, and chest
- Swollen, painful liver
Severe ascites (fluid accumulation in the abdominal cavity)
- Substantial loss of appetite
- Fainting (syncope) in response to movement
- Sudden weight gain
- Increased urge to urinate
- Swollen Halsvenen
- Forgetfulness and confusion
The conditions that cause predominantly right-sided heart failure differ from those that cause predominantly left-sided heart failure and can be divided into three categories.
Pulmonary hypertension is increased blood pressure in the pulmonary artery. It can lead to right-sided heart failure, as the walls of the right side of the heart are thin and pump relatively inefficiently under high-pressure conditions. If the right ventricle has to work against the increased pressure in the pulmonary artery for a long time, it begins to fail.
Pulmonary hypertension associated with right-sided heart failure can develop due to:
- Left-sided heart failure: In so-called “typical” heart failure, blood pressure in the pulmonary vascular system increases, which can eventually affect the right side of the heart. In fact, it is right to say that right-sided heart failure is a common and natural consequence of long-term or poorly treated left-sided heart failure.
- Pulmonary embolism: A large pulmonary embolism can cause the pressure in the pulmonary artery to increase acutely to very high levels. Smaller, recurrent pulmonary embolisms can gradually increase the pressure in the pulmonary artery, causing a more creeping appearance of right heart failure.
- Chronic lung disease: Chronic forms of pulmonary disease, especially chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea, can eventually lead to pulmonary hypertension and right heart failure.
- Acute respiratory distress syndrome (ARDS): This condition can cause an acute form of pulmonary hypertension and right heart failure.
- Congenital heart disease: In particular, atrial septum defects and ventricle septal defects can lead to pulmonary hypertension and right heart failure.
Other possible causes of pulmonary hypertension include primary pulmonary hypertension, scleroderma, sarcoidosis or various forms of vasculitis that affect the lungs.
Valvular Heart Disease
Any type of heart valve disease, the main effect of which is to increase pressure within the right side of the heart or to hinder blood flow through the right side of the heart, can cause right-sided heart failure.
This might include:
- Regurgitation (leakage) of the tricuspid and pulmonary valves due to pulmonary hypertension
Stenosis (narrowing) of the tricuspid or pulmonary valve due to congenital or rheumatic heart disease affecting other parts of the heart: (A tricuspid or pulmonary valve disease in itself is a rare cause of right-sided heart failure).
- Stenosis of the mitral valve – the valve that lies between the left atrium and the left ventricle – is a common cause of right-sided heart failure: blood flowing back from the lungs into the left atrium tends to “stow” in mitral stenosis, which leads to increased vascular pressure in the lungs, which eventually leads to pulmonary hypertension and right-sided heart failure.
Right Ventricular Myocardial Infarction
People suffering a myocardial infarction (heart attack) caused by a blockage in the right coronary artery can suffer from damage to the right ventricle muscle, leading to right-sided heart failure.1 Treatment of a right ventricular heart attack is similar to the treatment of any myocardial infarction, including the rapid opening of the blocked blood vessel.
However, since right-sided heart failure can limit the amount of blood reaching the left side of the heart, drugs that are primarily aimed at treating left-sided heart failure (e.B.g. nitrates, beta-blockers, and calcium channel blockers) must be used with great caution in people with a right ventricular heart attack.
Diagnosis of right-sided heart failure usually requires a thorough physical examination by a cardiologist, as well as an anamnesis and a series of tests. When checking the medical history, he will be particularly suspicious of heart failure if you have already had deep vein thrombosis or pulmonary embolism.
Tests used to diagnose right-sided heart failure include:
- Electrocardiogram (ECG) and echocardiogram examinations, which can show increased pressure in the pulmonary artery and can also reveal heart valve diseases or diseases of the heart muscle.
- lung function tests to confirm the presence and severity of COPD
- Blood tests to measure substances in the blood released in response to heart failure and to assess kidney, liver, and thyroid function
- Sleep study to determine if apnea is a factor
- Computed tomography (CT), a 3-D X-ray image of the heart
- Magnetic resonance imaging (MRI), in which detailed images of the heart are created using radio waves, magnets, and a computer
- Cardiac catheter examination in which a catheter is inserted into a chamber or vessel of the heart to diagnose blockages and defects
- Coronary anarangiography in which a dye seen on an X-ray is injected into the ventricles to make blood flow through the heart visible
- Chest X-rays to determine if the heart is enlarged and/or the lungs are clogged
- Cardiac stress tests that assess heart function during exposure under controlled conditions: Together with an ECG, the test can show changes in heart rate, rhythm, or electrical activity of the heart and blood pressure.
Adequate treatment of right-sided heart failure depends on the identification and treatment of the underlying cause:
- If the cause is a heart valve disease (usually mitral stenosis), surgical repair or replacement of the diseased valve is necessary.
- If a right ventricular myocardial infarction is the cause, aggressive and rapid treatment is required to open the blocked right coronary artery.
- If the underlying cause is left-sided heart failure, treatment must be optimized for this condition.
- If the cause is a pulmonary disorder (i.e. if there is a cor pulmonary disorder), the treatment of the underlying lung problem must be optimized.
While the underlying disease process is identified, medications can be prescribed, including:
- Careful use of diuretics to relieve excessive edema
- Medicines to reduce pressure in the pulmonary artery
- A low-fat, low-cholesterol, and low-sodium diet to improve symptoms
- Gentle aerobic training to strengthen the heart
- A VAD implant (Ventricular Assist Device) to help a weak heart pump more efficiently
Although this is only a last resort, right-sided heart failure is sometimes treated with a heart transplant, in which the damaged heart is surgically removed and replaced by a healthy heart of a deceased donor.
If you have been diagnosed with heart failure, it is important that you take proactive action in the treatment of your disease. In some cases, medication adjustments and lifestyle changes may be sufficient to alleviate the symptoms:
- Eat healthily with lots of fresh fruit and vegetables
- Reduce salt
- Keep a healthy weight
- Increase your physical activity (under the guidance of your doctor when you are moving for the first time)
- Stop smoking
- Reduce or give up alcohol consumption altogether
- Maintain a strong social network
- Reduce stress
A Word From Verywell
The prognosis for the recovery from right-sided heart failure depends on the cause of the disease and the severity of the symptoms. Although the situation may improve in some people through treatment and lifestyle changes, others may require an implant or a heart transplant. Since it is a serious condition that can even lead to premature death, it is crucial that you receive a thorough medical examination if you notice symptoms and that you act quickly to reverse or improve the underlying cause.