Right-side Heart Failure

Introduction:

Right-sided heart failure occurs frequently as a result of left ventricular failure due to volume and pressure overload. The signs and symptoms seen in patients clinically are chest discomfort, breathlessness, palpitations, and body swelling. In this type of heart failure, the right ventricle of the heart becomes weak to pump enough blood to the lungs.

What Is Right Side Heart Failure?

Right-sided heart failure is one of the kinds of heart failure, also known as right ventricular (RV) heart failure or right heart failure. The right side of the heart pumps used blood from the body back to the lungs, where it is refilled with oxygen. Right-sided heart failure means that the right ventricle of the heart is very weak to pump sufficient blood to the lungs due to which blood is built up in the veins, vessels that carry blood from the body back to the heart. This buildup leads to an increase in the pressure in the veins. This pressure pushes fluid out of the veins and into other tissues. Fluid gets built up in the legs, abdomen, or other areas of the body, resulting in swelling.

What Is Left Sided Heart Failure?

The left side of the heart pumps fresh blood to the whole body via the circulatory system. The left ventricle is larger and stronger than the right because its function is to pump more blood through the entire body. When people have left-sided heart failure, the left side of the heart has to work hard to pump the same amount of blood. Left-sided heart failure is the most frequent cause of right-sided heart failure.

How Common Is Right Sided Heart Failure?

Heart failure is rarely seen in people younger than 50 years of age. With age, it becomes more common. Various studies revealed that around two percent of the population younger than 54 years of age have heart failure. The number increases to around eight percent for about 1 in 12 people above 75 years of age.

What Causes Right Sided Heart Failure?

Many cases of right-sided heart failure are seen because of left-sided heart failure. The complete heart gradually weakens. Mostly, left-sided heart failure is the result of some other heart condition like:

• Coronary artery disease.

• Increased blood pressure.

• Prior heart attack.

In some cases, right-sided heart failure can occur due to:

• Increased blood pressure in the lungs.

• Pulmonary embolism.

• Lung diseases like chronic obstructive pulmonary disease (COPD).

How Does Left Sided Heart Failure Cause Right Sided Heart Failure?

People who have advanced left-sided heart failure mostly end up with right-sided heart failure. When the left ventricle is not able to work efficiently:

• The left ventricle starts pumping less blood out to the body.

• The reduced flow of blood results in the backup of blood behind the left ventricle, into the left atrium, lungs, and ultimately the right ventricle.

• The backup causes increased blood pressure, which causes damage to the right side of the heart. This damaged right side of the heart stops pumping efficiently, and blood is built up in the veins.

• As the pressure of the veins gets elevated, the fluid is pushed into the surrounding tissues.

• This buildup of fluid results in swelling and congestion throughout the entire body.

What Are the Symptoms of Right Sided Heart Failure?

The primary sign of right-sided heart failure is the buildup of fluid. This buildup leads to swelling (edema) in the following places:

• Feet, ankles, and legs.

• Lower back.

• Gastrointestinal (GI) tract and liver (causing ascites).

Some other signs are:

• Breathlessness.

• Chest pain and discomfort.

• Heart palpitations.

The accumulation of fluid depends on the extra fluid and the position of an individual. If a person is standing, fluid builds up frequently in the legs and feet. If they are in the lying down position, it may build up in the lower back. And if they have a lot of excess fluid, it may even build up in the belly region.

Fluid buildup in the liver or stomach might cause:

• Nausea.

• Bloating.

• Appetite loss.

Once right-sided heart failure becomes advanced, one can also lose weight and muscle mass. Doctors call these effects cardiac cachexia.

How Is Right Sided Heart Failure Diagnosed?

For the diagnosis of the right-sided heart failure, the doctor:

• Enquires about the symptoms. Frequently, this can be sufficient for them to suspect heart failure.

• They perform a physical exam by taking pulse and blood pressure, listening to the heart and lung sounds, and checking for signs of swelling.

The doctor tests the functioning of the heart by performing:

• Chest X-ray.

• Electrocardiogram (EKG).

• Echocardiogram.

• Blood tests, detect the presence of substances called natriuretic peptides (NPs).

For confirmatory diagnosis of heart failure or to rule out other conditions that cause the symptoms, some other methods like MRI (magnetic resonance imaging), CT (computed tomography) scan, cardiac catheterization, stress test, and nuclear exercise stress test are also advised.

How Is Right Sided Heart Failure Managed?

The treatment of right-sided heart failure is aimed at the cause of the heart failure, and not all of the causes of right-sided heart failure are treatable. But by treatment of heart failure, improvement in symptoms is possible. Generally, a combination of lifestyle changes, medications, and heart devices can help in managing heart failure and living an active life.

What Lifestyle Changes Can Help in Treating Right Sided Heart Failure?

A few lifestyle changes can help in improving the symptoms and slow the progress of the disease. Most of the people with mild heart failure enhance their quality of life by taking certain steps like:

• Quitting smoking.

• Working towards maintaining a healthy weight.

• Tracking the daily fluid intake. They may need diuretic medication to help get rid of extra fluid in the body.

• Eating a heart-healthy diet. A dietitian or nutritionist can help people in forming a healthy, filling meal plan.

• Managing stress, either through yoga, meditation, or a few other stress management techniques.

• By doing regular exercise.

• Having good sleep at night.

• Following guidelines for sexual activity for people with heart failure.

• Avoiding alcohol.

• Limiting caffeine intake.

• Staying on top of the health by keeping track of any symptoms that are not usual. If anything changes, talk to the doctor.

• Monitoring the blood pressure at home, in addition to regular appointments with the doctor.

• Get all recommended seasonal vaccinations like COVID-19, pneumonia, and flu vaccinations.

Conclusion:

Right-sided heart failure is seen due to insufficient blood reaching the heart. This is seen as a result of left ventricular failure due to an overload of volume and pressure. People with such disease often feel chest discomfort. This can be managed by taking certain lifestyle changes.