Right-sided heart failure

Overview

Right-sided heart failure is heart failure that affects the lower right heart chamber, called the right ventricle. Right-sided heart failure makes it hard for the right ventricle to pump blood. When this happens, fluid can build up in the belly, legs and feet.

Right-sided heart failure is common. Proper treatment may improve the symptoms of heart failure and may help some people live longer. But right-sided heart failure can be life-threatening. Some people may need heart transplants or devices to help the heart pump blood.

Right-sided heart failure also may be called right heart failure or right ventricular failure.

Types

There are different types of heart failure. The condition can affect the right or left side of the heart or both.

• Right-sided heart failure. This type affects the lower right heart chamber, called the right ventricle. It can happen because of heart failure on the left side of the heart. Lung disease and pulmonary hypertension also are common causes. Fluid may build up in the belly, legs and feet, causing swelling. The condition is called cor pulmonale when lung disease causes pulmonary hypertension and the right side of the heart becomes larger than usual and does not pump well.
• Left-sided heart failure. This type affects the lower left heart chamber, called the left ventricle. This is the heart's main pumping chamber. Fluid may build up in the lungs, causing shortness of breath. Over time, left-sided heart failure can affect the right side of the heart if pressure in the lungs goes up.
• Heart failure with reduced ejection fraction (HFrEF), also called systolic heart failure. This is a type of left-sided heart failure. The left ventricle doesn't squeeze as strongly as it should, so it pumps less blood.
• Heart failure with preserved ejection fraction (HFpEF), also called diastolic heart failure. This is a type of left-sided heart failure. The left ventricle can't relax or fill as well as it should.
• Heart failure with improved ejection fraction (HFimpEF), formerly called heart failure with recovered ejection fraction (HFrecEF). In this subtype of left-sided heart failure, the ejection fraction was reduced in the past but has improved. This means a low ejection fraction is not always permanent. But heart failure can come back, so treatment usually needs to continue.

Causes

Right-sided heart failure can have many causes. The most common cause is left-sided heart failure. Other causes can raise blood pressure in the lungs, damage the right ventricle or make it work harder.

• Left-sided heart failure. The left ventricle doesn't pump or fill well. Pressure can then build up in the blood vessels in the lungs. This raises pressure in the lungs and makes the right ventricle work harder.
• Pulmonary hypertension. This is high blood pressure in the arteries of the lungs. The higher pressure makes the right ventricle work harder.
• A blood clot in the lung, called pulmonary embolism. A pulmonary embolism is a blood clot that blocks an artery in the lung. It can suddenly increase pressure in the lung and make the right ventricle work harder.
• Coronary artery disease and heart attack. Coronary artery disease can reduce blood flow to the heart and may lead to a heart attack. A heart attack can damage the heart muscle. A heart attack that damages the right ventricle can cause right-sided heart failure.
• Chronic obstructive pulmonary disease or other lung diseases. Long-term lung disease can cause pulmonary hypertension.
• Heart valve disease. Issues with the tricuspid or pulmonary valve can cause right-sided heart failure.
• Disease of the heart muscle, called cardiomyopathy.

Other causes

• Swelling of the heart muscle, called myocarditis.
• Irregular heartbeats, called arrhythmias. Irregular heartbeats may cause the heart to beat too fast, creating extra work for the heart. A slow heartbeat also may lead to heart failure.
• A heart condition that you're born with, called a congenital heart defect. Some heart defects present at birth can make the heart work harder. Over time, this may lead to heart failure.
• Other diseases. Some long-term conditions can contribute to heart failure. These conditions include high blood pressure, obesity, diabetes and thyroid disease. Other conditions that may contribute to heart failure include diseases that cause iron or altered proteins to build up in the heart.

Complications

If you have right-sided heart failure, it's important to have regular health checkups, even if symptoms improve. Your healthcare professional can examine you and do tests to check for complications.

Complications of heart failure depend on your age, overall health and how serious your heart disease is. They may include:

• Kidney damage or failure. Heart failure can reduce blood flow to the kidneys. Untreated, this can cause kidney failure. Kidney damage from heart failure can require dialysis for treatment.
• Irregular heartbeats. Heart failure can raise the risk of irregular heartbeats. Some irregular heartbeats can make heart failure worse. Some types of irregular heartbeats can lead to a life-threatening condition called sudden cardiac arrest.
• Liver damage. Heart failure can cause fluid buildup that puts too much pressure on the liver. This fluid backup can lead to scarring, which makes it harder for the liver to work properly.
• Poor nutrition or digestive issues. Fluid buildup in the stomach and intestines can make you lose your appetite and make it harder for the body to absorb nutrients.
• Sudden cardiac arrest. If the heart is weak, there is a risk of dying suddenly due to a dangerous irregular heart rhythm.

Treatment

Treatment of right-sided heart failure depends on the cause of the heart failure and how severe it is. Treatment can help improve symptoms, remove extra fluid and reduce strain on the right side of the heart. If another health condition is causing right-sided heart failure, treating that cause may help.

With treatment, symptoms of heart failure may improve. Treatment may include lifestyle changes and medicine. Some people with right-sided heart failure need a heart procedure, heart device or heart transplant.

Lifestyle changes

Lifestyle changes are an important part of heart failure treatment. They can help you feel better, stay active and manage other conditions that can make right-sided heart failure worse. Your healthcare team may suggest these lifestyle changes:

• Don't smoke. Smoking damages the heart and blood vessels. It can raise blood pressure and lower oxygen levels in the blood. Quitting is the best way to reduce the risk of heart disease. If you need help quitting, talk with your healthcare professional. Also avoid secondhand smoke. You can't be considered for a heart transplant if you continue to smoke.
• Manage weight. Extra weight can raise the risk of heart disease and heart failure. Ask your healthcare professional what weight is healthy for you.
• Eat a heart-healthy diet. Choose more fruits and vegetables, whole grains, fat-free or low-fat dairy products, and lean proteins. Limit saturated and trans fats.
• Limit salt. Too much salt, also called sodium, can make the body hold onto extra fluid. This can make swelling and other heart failure symptoms worse. Ask your healthcare professional how much salt is right for you. Check food labels and remember that prepared, packaged and restaurant foods can contain a lot of sodium.
• Limit alcohol. Drinking too much alcohol can weaken the heart muscle and lead to heart failure. If you have heart failure, ask your healthcare professional how much alcohol, if any, is safe for you.
• Ask how much fluid you can drink. Some people with heart failure need to limit how much they drink. Your healthcare professional may suggest that you limit the amount of fluid you drink.

Medicines

A combination of medicines may be used to treat heart failure. The medicines you use depend on the cause and type of heart failure. Medicines may include:

• Diuretics. These medicines help the kidneys remove extra salt and water to prevent fluid buildup in your body. Your care team may adjust your dose to make sure the medicine isn't removing too much fluid, which can lower blood pressure or reduce blood flow.
• Angiotensin-converting enzyme (ACE) inhibitors or angiotensin 2 receptor blockers (ARBs). These medicines relax blood vessels to lower blood pressure, improve blood flow and decrease strain on the heart. ARBs may be a choice for people who can't take ACE inhibitors.
• Angiotensin receptor plus neprilysin inhibitors (ARNIs). This type of medicine combines a neprilysin inhibitor and an angiotensin receptor blocker. It's used to treat some people who have heart failure with reduced ejection fraction. ARNIs may lower the risk of a hospital stay.
• Beta blockers. These medicines slow the heart rate and lower blood pressure. They reduce the symptoms of heart failure and help the heart work better. Beta blockers also help control irregular heartbeats.
• Sodium-glucose cotransporter-2 (SGLT2) inhibitors. These medicines help lower blood sugar. They are often prescribed to people who have type 2 diabetes. But they're also used to treat some types of heart failure. Several studies have shown that the medicines can lower the risk of hospital stays and death in people with certain types of heart failure, even those who don't have diabetes.

Your healthcare professional may prescribe other medicines to treat or prevent causes of right-sided heart failure.

Heart device

Some people with advanced heart failure may need heart devices called ventricular assist devices (VADs). A VAD helps pump blood from the lower chambers of the heart to the rest of the body. It's also called a mechanical circulatory support device. When the device is used for right-sided heart failure, it is called a right ventricular assist device. It provides short-term support for the lower right heart chamber.

Surgery or other procedures

Surgery and other treatments may be recommended to treat a cause or complication of heart failure. They may include:

• Coronary angioplasty and stents. Angioplasty is a procedure that opens blocked blood vessels that supply the heart. A small mesh tube called a stent may be placed in the artery to help keep it open and improve blood flow to the heart muscle.
• Coronary artery bypass surgery. A surgeon uses a healthy blood vessel from another part of the body to create a new path for blood to flow around a blocked coronary artery. This improves blood flow to the heart muscle.
• Heart valve surgery. If a damaged heart valve causes heart failure, your healthcare professional may recommend repairing or replacing the valve. There are many different types of heart valve surgery. The type needed depends on the cause of the heart valve disease. Heart valve repair or replacement may be done as open-heart or minimally invasive surgery.
• Extracorporeal membrane oxygenation (ECMO). With ECMO, a machine pumps blood to a heart-lung machine. The machine removes carbon dioxide and sends oxygen-rich blood back to the body. Blood flows from the right side of the heart to the heart-lung machine. The blood is rewarmed and goes back to the body.
  
  ECMO lets blood go around the heart and lungs. This allows the heart and lungs to rest and heal. ECMO does not treat or cure diseases. But it can give short-term support while your care team treats the cause or considers other treatment options.
• Heart transplant. Some people have such severe heart failure that surgery or medicines don't help. These people may need to have their hearts replaced with healthy donor hearts. A heart transplant isn't the right treatment for everyone. A team of healthcare professionals at a transplant center helps determine whether the procedure may be safe and helpful for you.

Your healthcare professional also treats the cause of the heart failure. For example, treatment may include a procedure to remove a blood clot from a lung. Or you may have surgery to repair a congenital heart defect.

Symptom care and end-of-life care

Your healthcare professional may recommend special medical care to reduce symptoms and improve quality of life. This is called palliative care. Anyone who has a serious or life-threatening illness can benefit from this type of care. It can be used to treat symptoms of the disease or to ease the side effects of treatment.

In some people with heart failure, medicines no longer work and a heart transplant or device isn't an option. If this occurs, special end-of-life care may be recommended. This is called hospice care.

Hospice care allows family and friends — with the aid of nurses, social workers and trained volunteers — to care for and comfort a loved one. Hospice care is available at home or in nursing homes and assisted living centers.

Hospice care provides emotional, psychological and spiritual support for those who are sick and their loved ones.

Prognosis

The outlook for right-sided heart failure varies from person to person. It depends mostly on what caused the right-sided heart failure and how well both lower heart chambers are working.

People who have right-sided heart failure and a heart valve disease called tricuspid valve regurgitation have a higher risk of hospital stays and death.

Your prognosis also depends on whether right-sided heart failure has affected other organs, including the kidneys and liver.

It can be hard to predict exactly what will happen for one person with right-sided heart failure. The cause and severity vary from person to person. In general, more-serious heart failure is linked to a worse outlook. There is no single life expectancy number that applies to everyone.

Self-care

You can take an active part in your care. Follow the heart failure treatment plan from your care team. Your care team may ask you to:

• Check your legs, ankles and feet for swelling. Do this every day. Call your care team if the swelling gets worse.
• Weigh yourself. Ask your care team how often you should do this. Weight gain may mean your body is holding onto fluid. You may need a change in treatment. Call your team if you gain 5 pounds (2.3 kilograms) within a few days.
• Stay as active as possible. Regular physical activity can help improve your ability to exercise. Talk with your care team about what type and amount of activity are safe for you. The team may advise a cardiac rehabilitation program.
• Reduce stress. Living with heart failure can cause stress and anxiety. Relaxation techniques can help you manage stress. Practicing mindfulness or tai chi is a way to lessen and manage stress.
• Get better sleep. Some people who have heart failure also have trouble sleeping. Try sleeping with your head propped up using a pillow or a wedge. If you have trouble sleeping or have a sleep condition such as sleep apnea, talk with your healthcare team.
• Get recommended vaccinations. Ask your care team about getting influenza, pneumonia and COVID-19 vaccines.

Heart failure action plan

Healthcare professionals recommend that all people with heart failure have an action plan to help guide their self-care at home. A heart failure action plan, also called a self-check plan, provides clear instructions for you and your caregivers to follow should any new symptoms occur. You can work with your healthcare team to create a plan that's best for your type of heart failure and your basic abilities.

According to the American Heart Association, a typical plan can fall into three zones:

• Green = stable. You don't have noticeable changes in heart failure symptoms. Your weight is stable. You don't have chest pain or shortness of breath. Continue your daily weight checks and treatment plan as advised.
• Amber = warning. Call your healthcare team if you have a new cough, shortness of breath with activity, or increased swelling in your legs or feet. Call if you suddenly gain 2 to 3 pounds (about 1 to 1.5 kilograms) overnight or 5 pounds (2.3 kilograms) in a week. You might not need an office visit. But you also might need to change your diet or medicines. Follow the instructions in your plan.
• Red = danger. Go to the emergency room or call your local emergency number if you have heart failure and have gained more than 5 pounds (2.3 kilograms) in a week. Also seek help if you can't lie flat, are short of breath at rest, have increased swelling and discomfort in the lower body, or have a constant, hacking cough.

Strictly following your action plan can help your healthcare professional quickly treat new health issues and manage your care. If you stick to your self-care or action plans, you might reduce the times you go to a hospital or shorten your stays.

Preparing for an appointment

If you have symptoms that may be caused by heart failure, make an appointment with your healthcare professional. You may be sent to a doctor trained in heart diseases. This type of doctor is called a cardiologist.

Appointments can be brief. Because there's often a lot to talk about, it's a good idea to be prepared for your appointment. Here's some information to help you get ready.

What you can do

• When you make the appointment. Ask if there's anything you need to do in advance. For example, you may be told not to eat or drink for a while before some tests.
• Write down any symptoms you're having, including any that may seem unrelated to heart failure.
• Write down key personal information, including a family history of heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes. Find out if anyone in your family has had heart failure. Some heart conditions that cause heart failure can occur in families. Knowing as much as you can about your family history can be helpful.
• Make a list of all medicines, vitamins and supplements that you're taking. Include doses. Bring this list with you to all health checkups.
• Take someone along, if possible. Sometimes it can be hard to remember all the information you get during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare professional. For example, if you have heart failure you might ask whether it's safe for you and your partner to have sex. If you have more-serious symptoms, do not have sex until your heart failure is managed. If you have questions, talk with your healthcare professional.

Your time with your healthcare professional is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out.

For heart failure, some basic questions to ask your healthcare professional include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests will I need? Do these tests require any special preparation?
• What treatments are available? Which do you recommend for me?
• Is there a generic available for the medicine you're prescribing for me?
• Do my family members need to be screened for conditions that may cause heart failure?

Other questions to ask your healthcare professional include:

• What foods should I eat or avoid?
• Do I need to limit salt?
• What's the right level of physical activity for me?
• Do I have any activity restrictions?
• How often should I be screened for changes in my condition?
• I have other health conditions. How can I best manage them together?
• Is there any information that I can take home with me? What websites do you recommend?

What to expect from your doctor

Your healthcare professional is likely to ask many questions. Being ready to answer them may save time to go over any details you want to spend more time on. Your healthcare professional may ask:

• When did you first notice your symptoms?
• Do your symptoms occur all the time, or do they come and go?
• How bad are your symptoms?
• What, if anything, seems to make your symptoms better?
• Does anything make your symptoms worse?