Right-sided heart failure is when the right side of the heart loses its ability to pump blood efficiently. It is often a complication of other conditions.
Causes, incidence, and risk factors: Right-sided heart failure occurs in about 1 out of 20 people. Coronary artery disease is the most common cause of heart failure in the United States.
Heart failure may affect the right side of the heart (right ventricle), the left side (left ventricle), or both sides of the heart. In right-sided heart failure, the right ventricle loses its pumping function and blood may back up into other areas of the body, producing congestion. Congestion affects the liver, the gastrointestinal tract, and the limbs. In addition, the right ventricle may be unable to pump blood efficiently to the lungs and to the left ventricle.
Causes of right-sided heart failure include left-sided heart failure and lung diseases such as chronic bronchitis and emphysema. Other causes include congenital heart disease, clots in pulmonary arteries, pulmonary hypertension, and heart valve disease.
Signs and tests: Your health care provider will conduct a physical examination, which may reveal:
Heart failure patients may undergo some of the following common tests:
- An ECG may show signs of thickened heart muscle or enlarged heart chambers. The electric system of the heart and heart rhythm may not be normal.
- A chest x-ray may show enlargement of the heart and fluid accumulation in the lungs.
- An echocardiogram (heart ultrasound) and a Doppler study may show heart chambers enlargement, leaky valves, and poor pumping function.
The following routine lab tests may be performed:
Cardiac catheterization may be performed:
- Right heart catheterization: a catheter is inserted through a vein into the right side of the heart and the pressures there are measured.
- Sometimes, a dye injection in the right ventricle is necessary to help understand the problem (right ventriculography).
- The left ventricle and arteries may also need to be studied, with a coronary angiography and left ventriculography.
Treatment: Heart failure requires periodic monitoring by your health care provider. The goals of treatment include controlling the symptoms, reducing the workload of the heart, and improving your heart's ability to function. Any underlying disorders and causes should be treated, if possible.
The most common therapy for right-sided heart failure is treating left-sided heart failure.
Valve replacements and procedures like bypass surgery (CABG) and angioplasty are the solution for some people.
LIFESTYLE
Generally, you must reduce the salt in your food and how much fluids you drink. You should also consider losing weight if you are overweight, stop smoking, and avoid drinking too much alcohol.
MEDICATION
Diuretic drugs (water pills) can help reduce fluid accumulation. Furosemide or bumetanide can help moderate to severe symptoms. Hydrochlorothiaze, chlorthalidone, and chlorothiazideor may be used for mild symptoms. Another drug, spironolactone, can prevent salt retention and help patients with severe heart failure.
Medications that reduce your heart's workload include ACE inhibitors, ARBs, and drugs such as hydralazine and long-acting nitrates. They can prolong the life of very sick patients with failing hearts.
Beta-blockers (such as metopropol or carvedilol) can help prevent death in some heart failure patients.
Digitalis may be prescribed to increase the muscle contraction of the heart and help prevent hospitalization.
IMPLANTED DEVICES
Some patients with ECG abnormalities may benefit from a special kind of pacemaker, called a biventricular pacemaker. This helps both ventricles contract together (CRT, cardiac resynchronization therapy). A defibrillation device such as an implantable cardioverter-defibrillator (ICD) helps some patients. CRT and ICD may be combined and implanted in a single device (biventricular pacemaker-ICD).
TRANSPLANTS
Severe heart failure that doesn't respond to these therapies may require a heart transplant.
Expectations (prognosis): Heart failure is a serious disorder. The heart's pumping problems must be kept from getting worse, as much as possible.
There is no cure, but many forms of heart failure can be controlled with medication, addressing the underlying disorders, and implanted devices with defibrillation capabilities.
Complications: - Arrhythmias (abnormal heart rhythms), which may be life-threatening
- Fainting
- Repeat hospitalizations
- Side effects of heart failure medications
Prevention: Follow your health care provider's recommendations for treating conditions that may cause congestive heart failure. Follow dietary guidelines -- in particular, reduce salty foods and avoid adding salt to meals. Reduce or stop smoking and alcohol.
