Everything to know about right sided heart failure

Article By: Amy Carmosino

If a person has right sided heart failure, it means the right side of their heart is not pumping blood to the lungs as effectively. The condition can develop if a person has already experienced weakness in the left side of the heart. Experts also refer to right sided heart failure as pulmonary heart disease.

When a person experiences heart failure, it means the heart muscle is not strong or flexible enough to pump blood throughout the body.

The right side of the heart takes deoxygenated blood that has already been through the heart and pumps it out into the lungs. The lungs then replenish it with oxygen.

In right sided heart failure, the right ventricle of the heart is unable to pump enough blood to the lungs.

This often happens due to failure in the left side of the heart. Increased fluid and pressure then pass through the right side of the heart muscle and into the lungs.

Consequently, the right side of the heart becomes weaker and damaged. There is also a build-up of blood in the veins, which can cause dispersion of fluid to surrounding tissues. This in turn can lead to swelling throughout the body, including the:

Right sided vs. left sided heart failure
When right sided heart failure occurs, the increased pressure in the veins causes dispersion of fluid to surrounding tissues. This happens because this side of the heart is too weak to pump blood forward to the lungs.

The result may be a build-up of fluid in various parts of the body, including the legs, abdomen, and liver.

By contrast, when left sided heart failure occurs, it means the left ventricle is not pumping enough blood throughout the body. Blood then accumulates in the pulmonary veins, which are blood vessels that carry blood away from the lungs.

When left sided heart failure occurs, a person can experience the following:

difficulty breathing
shortness of breath
While left sided heart failure is the most common type of heart failure, it can lead to right sided heart failure.

Right sided heart failure symptoms
A person with isolated right sided heart failure may experience the following:

pain or discomfort in the chest
swollen ankles or feet
unexplained weight gain
feeling full after eating little
abdominal pain or fullness

Causes of right sided heart failure
Right sided heart failure can be due to the following conditions:

Left sided heart failure
Left sided heart failure is the primary cause of right sided heart failure.

When the left ventricle is not working as effectively, fluid pressure increases and ends up moving back through the lungs. This can cause an overload to the heart’s right side.

Consequently, when the right side is unable to pump blood, fluid accumulates in the veins, resulting in swelling.

Pulmonary hypertension
Right sided heart failure is the main consequence of pulmonary hypertension, which is when there is high blood pressure in the blood vessels that deliver oxygen-rich blood to the lungs.

If there are changes in the small blood vessels inside the lungs, high blood pressure can occur in the right side of the heart. As a result of the added strain, the heart has difficulty pumping blood to the lungs.

Chronic conditions such as pulmonary embolism and chronic obstructive pulmonary disease (COPD) and diseases that cause difficulty breathing, including chronic bronchitis and emphysema, can cause strain on the right side of the heart.

Congenital heart conditions
Abnormal heart function can result from structural heart conditions that are present at birth. Conditions may include:

abnormal heart valves
abnormal blood vessels
improper formation of the heart
These conditions may affect how blood flows through the heart and to the rest of the body.

Pulmonic stenosis
A person with pulmonic stenosis experiences a narrowing of the pulmonic valve. This decreases blood flow out from the right ventricle, which then needs to work harder.

Similar to chronic lung disease, this extra strain can cause the right ventricle to fail over a period of time.

Other possible causes
Other causes of right sided heart failure include:

Valvular heart disease: If one of the four heart chambers is damaged, this may prevent the heart from pumping blood the way it should.
Sleep apnoea: People who experience sleep apnoea breathe differently when they sleep. This can increase pressure in the left and right ventricles of the heart and lead to right sided heart failure.
Carcinoid heart disease: Tumours in the heart usually affect the right side. This then can cause right sided heart failure.
How to diagnose right sided heart failure
To diagnose right sided heart failure, a cardiologist, who specializes in the treatment of disorders of the heart and blood vessels, will perform a thorough exam. This can include a medical history evaluation and other tests, such as:

Electrocardiogram (EKG): With the help of EKG, doctors can detect elevated pulmonary artery pressure, valvular heart disease, and other conditions affecting the heart.
Echocardiogram: Sound waves help take moving pictures of the heart and identify how its right side is working.
Pulmonary function test: This test can verify the presence of COPD and determine its severity.
Blood tests: Doctors use these to assess the functioning of the liver, kidney, and thyroid. Blood tests can also help detect heart failure and determine whether a substance called brain natriuretic peptide is present.
Chest X-ray: These scans help determine whether the lungs are congested and whether the heart is enlarged.
CT scan: CT scans take X-rays of the chest.
MRI scans: MRI scans use radio waves, magnets, and a computer to create detailed pictures of the heart.
Cardiac catheterization: Doctors insert a catheter into the right-side ventricle of the heart to measure pressure, or into the coronary arteries to look for blockages in the blood flow to the blood vessels around the heart.

Right sided heart failure treatment
Treatment for right sided heart failure aims to manage symptoms.

Treating risk factors for pulmonary hypertension is an important step toward keeping this condition under control.

Doctors will recommend treatment options depending on the cause of the condition.

If a person has right sided heart failure, a doctor may need to remove extra sodium and fluid and relax blood vessels. Medications will aim at:

reducing fluid retention
decreasing loss of potassium
opening narrowed blood vessels to improve blood flow
lowering blood pressure
slowing heat rate
increasing blood flow
reducing swelling
promoting urination
preventing blood clots
lowering cholesterol
helping the heart beat more strongly
Behavioural changes
A person with a right sided heart failure diagnosis may need to make certain behavioural changes, including:

avoiding strenuous activity
avoiding high altitudes
quitting smoking, if applicable
limited salt consumption
reducing intake of fluids
using oxygen
avoiding pregnancy
Learn about how to follow a cardiac diet here.

If medication and lifestyle changes prove ineffective, a doctor may recommend a transplant of a lung, the heart, or both.

Learn more about organ transplants here.

A person with right sided heart failure will likely need treatment for the rest of their life.

While there is currently no cure, there are steps a person can take to manage symptoms and treat the cause of their heart failure.

Chronic right sided heart failure can be a result of a number of conditions, including left sided heart failure.

A person with a right sided heart failure diagnosis should consult a doctor to find the most suitable management and treatment options. Researchers are working to develop new therapies. However, treatment may last for the rest of a person’s life.

Making lifestyle changes, such as reducing stress and avoiding alcohol, can help reduce symptoms. It is also important to manage contributing health factors, such as blood pressure and anaemia.


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