Right-Sided Heart Failure: Pathophysiology and Clinical Implications

Introduction

Right-sided heart failure (RHF) is a condition in which the right ventricle fails to effectively pump blood into the pulmonary circulation. This results in blood backing up into the systemic venous system, leading to fluid accumulation and organ congestion.

Pathophysiology of Right-Sided Heart Failure

1. Causes of Right-Sided Heart Failure

RHF is most often caused by left-sided heart failure, but other conditions can also directly affect the right ventricle. Common causes include: - Left-sided heart failure (leads to increased pulmonary pressure and right ventricular overload) - Chronic lung diseases like COPD (cor pulmonale) - Pulmonary hypertension - Right ventricular myocardial infarction - Congenital heart defects - Pulmonary embolism - Tricuspid or pulmonary valve disease

2. Mechanisms of Right Ventricular Failure

  • Increased Afterload: Conditions like pulmonary hypertension increase resistance in the pulmonary arteries, making it harder for the right ventricle to eject blood.
  • Decreased Contractility: Right ventricular ischemia or infarction weakens contraction strength.
  • Increased Preload: Tricuspid regurgitation leads to excessive blood volume in the right ventricle, causing dilation.
  • Ventricular Interdependence: The right ventricle shares the pericardial space with the left ventricle, meaning dysfunction in one chamber affects the other.

3. Clinical Manifestations

Right-sided heart failure presents with: - Peripheral edema (swelling in the legs, ankles, and feet) - Jugular venous distension (JVD) - Hepatomegaly and ascites (fluid accumulation in the abdomen) - Weight gain and fluid retention - Fatigue and weakness due to reduced cardiac output - Gastrointestinal symptoms like nausea and bloating due to venous congestion

Conclusion

Right-sided heart failure is a complex condition often secondary to left-sided failure or pulmonary disease. Early diagnosis and management are crucial to improving outcomes and preventing complications.

Source recommendations

1. American College of Cardiology/American Heart Association Guideline for the Management of Heart Failure

  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 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://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines
  4. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
  5. https://pubmed.ncbi.nlm.nih.gov/27206819/

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