Right-Sided Heart Failure

Introduction

Right-sided heart failure (RSHF) occurs when the right ventricle of the heart struggles to pump blood effectively to the lungs. This leads to blood backing up in the veins, causing fluid buildup in the body, especially in the legs, abdomen, and liver.

Causes of Right-Sided Heart Failure

RSHF is often a consequence of left-sided heart failure, but it can also stem from other conditions: - Left-sided heart failure – Increased pressure from the failing left side causes strain on the right side. - Chronic lung disease (e.g., COPD, pulmonary hypertension) – Increased resistance in the lungs makes the right ventricle work harder. - Pulmonary embolism – A blockage in the pulmonary arteries raises resistance, straining the right heart. - Congenital heart defects – Some birth defects impair right ventricular function. - Myocardial infarction (heart attack) affecting the right ventricle – Directly weakens right-sided pumping ability.

Symptoms of Right-Sided Heart Failure

• Swelling (edema) – More prominent in the legs, ankles, feet, and abdomen.
• Jugular vein distension (JVD) – Due to increased pressure in neck veins.
• Ascites – Fluid accumulation in the abdomen.
• Fatigue and weakness – Inadequate oxygen delivery to the body.
• Shortness of breath – Especially during exertion or while lying flat.
• Frequent urination at night (nocturia) – Caused by fluid redistribution when lying down.
• Enlarged liver (hepatomegaly) – Often with tenderness due to congestion.

Diagnosis

Doctors use several methods to diagnose RSHF: - Physical examination – Checking for swelling, JVD, and liver enlargement. - Echocardiogram – Assesses right ventricular function and pulmonary pressure. - Chest X-ray – Detects fluid buildup and heart enlargement. - Electrocardiogram (ECG) – Identifies signs of strain on the right side of the heart. - Blood tests (BNP, NT-proBNP) – Measure heart stress levels. - Cardiac MRI or CT scan – Provides detailed images of the heart.

Treatment Strategies

1. Lifestyle Modifications

• Reducing salt intake to prevent fluid retention.
• Managing weight and staying physically active.
• Stopping smoking and limiting alcohol intake.

2. Medications

• Diuretics – Reduce fluid overload.
• ACE inhibitors or ARBs – Help lower blood pressure and ease heart strain.
• Beta-blockers – Improve heart function and reduce workload.
• Pulmonary hypertension medications (if needed).

3. Surgical and Interventional Approaches

• Pacemakers or defibrillators – In certain cases of heart rhythm issues.
• Heart valve surgery – If valve disease is contributing.
• Heart transplant – In severe, untreatable cases.

Conclusion

Right-sided heart failure is a serious condition that requires careful management. Early diagnosis, appropriate treatments, and lifestyle changes can significantly improve a patient’s prognosis and quality of life.

Source recommendations

1. American College of Cardiology/American Heart Association (ACC/AHA) Heart Failure Guidelines

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://www.acc.org/Guidelines
3. https://www.jacc.org/doi/10.1016/j.jacc.2023.12.024
4. https://www.acc.org/education-and-meetings/products-and-resources/features/global-cv-institute/heart-failure-guidelines
5. https://professional.heart.org/en/science-news/-/media/832EA0F4E73948848612F228F7FA2D35.ashx

2. European Society of Cardiology (ESC) Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
2. https://pubmed.ncbi.nlm.nih.gov/34447992/
3. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
4. https://pubmed.ncbi.nlm.nih.gov/22611136/
5. https://academic.oup.com/eurheartj/article/44/37/3627/7246292