What causes right-sided heart failure

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.

In most cases, right sided heart failure results from problems that have already occurred in the left ventricle. However, it can also develop if a person is experiencing generalized heart failure or lung disease.

Blood can become blocked in the left ventricle and lungs. This puts extra stress on the right ventricle to pump the blood into the lungs. Over time, the right side of the heart can weaken and start to fail.

This article will outline the characteristics of right sided heart failure. It will also discuss its symptoms and causes and treatment options.

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 buildup 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:

• legs
• ankles
• abdomen
• gut
• liver

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 buildup 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
• coughing
• shortness of breath

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

Learn more about left sided heart failure here.

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 apnea: People who experience sleep apnea 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: Tumors in the heart usually affect the right side. This then can cause 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.

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.

Medication

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:

Behavioral changes

A person with a right sided heart failure diagnosis may need to make certain behavioral 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.

Surgery

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 anemia.

Heart failure is a general term for the weakening of the heart muscle that leaves it unable to pump enough blood to meet the body’s demands. There are several types of heart failure, each with its own cause and complications.

While treatment options vary, they usually involve a comprehensive approach to maintaining the health of your entire heart and circulatory system. The outlook for someone with right-sided heart failure depends on the severity of the disease, as well as how early treatment begins.

While it’s sometimes a life-threatening condition, it can be managed with a combination of medications, lifestyle changes, and in some cases, surgery.

The term heart failure sounds like the heart has stopped pumping, similar to how the phrase “engine failure” means an engine no longer produces any power.

Heart failure actually means that the heart muscle has grown weaker and can no longer provide sufficient blood flow to all parts of the body. The heart still pumps, just not as efficiently and effectively as it once did.

Right-sided heart failure involves the part of the heart responsible for pumping blood to the lungs, where it receives oxygen. The blood then travels throughout the body to deliver oxygen to your organs, muscles, and other tissues. Due to certain conditions, such as left-sided heart failure, the right ventricle may struggle to pump blood effectively to the lungs, weakening it over time.

As a result, the body doesn’t get all the oxygenated blood it needs to function, and complications affecting various other organs can develop.

What is left-sided heart failure?

Left-sided heart failure is a more common condition than right-sided heart failure. It happens when the left ventricle has to pump harder than usual to deliver enough blood to keep the body healthy.

There are two types of left-sided heart failure:

• heart failure with preserved ejection fraction, meaning the left ventricle can no longer relax enough to fill with the necessary amount of blood between heartbeats or functions at a much higher pressure
• heart failure with reduced ejection fraction, meaning the left ventricle can’t contract properly and the heart doesn’t have the force needed to pump blood out to the body

Fluid retention causing swelling in the lower limbs and sometimes the abdomen is a common and obvious symptom of right-sided heart failure. Still, there are several other symptoms that may develop:

Left-sided heart failure symptoms

Left-sided heart failure symptoms may look slightly different. Here are some symptoms of left-sided heart failure:

• shortness of breath
• coughing
• trouble breathing
• coughing/trouble breathing during physical activity
• shortness of breath during sleep (PND)

Several factors can weaken the heart and trigger heart failure.

Conditions that damage your heart, such as a heart attack, or make your heart work harder, such as valve disease, can have the same result. Right-sided heart failure can also occur due to lung disease or pulmonary hypertension.

Right-sided heart failure is most commonly brought on by left-sided heart failure. When the left side of your heart weakens, blood can build up within the chambers. This increases the pressure within the blood vessels carrying blood to the lungs — a condition known as pulmonary hypertension.

To compensate, the right side of the heart must work harder. Eventually, the right side weakens from the extra effort, and you develop right-sided heart failure.

Right-sided heart failure can also result from leaky or damaged right-sided valves, such as a leaky tricuspid valve (tricuspid regurgitation).

Specific risk factors for right-sided heart failure include:

• age, as the heart can weaken over time
• family history of heart failure and other heart conditions
• alcohol or drug misuse, smoking, or unbalanced diet
• medical conditions, including cardiovascular disease, hypertension, obesity, sleep apnea, and cancer (because some cancer treatments can injure the heart)

The proper treatment for right-sided heart failure depends on the underlying condition causing it. Treating right-sided heart failure usually involves using one or more medications, lifestyle measures, and possibly implanted devices that support the heart’s ability to pump. Treating left-sided heart failure is also important.

Medications

The following types of medications are among those commonly prescribed to treat right-sided heart failure:

• Diuretics. Diuretics help rid the body of excess fluid and sodium. Fluid management with diuretics is key to maintaining the right ventricle’s ability to fill with the proper amount of blood for each heartbeat. Special types of diuretics, known as potassium-sparing diuretics, can reduce the loss of potassium caused by fluid reduction.
• Vasodilators. These drugs help blood vessels relax, so the heart doesn’t have to work as hard and interrupt chemicals that weaken the heart. Two widely prescribed vasodilators include angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors.
• Beta-blockers. Beta-blockers help slow the heart rate, easing the workload of the heart muscle.
• Digoxin. Digoxin is a drug that helps strengthen the heart’s pumping ability. It’s typically used in more serious cases of heart failure.
• Pulmonary vasodilators. In cases of pulmonary hypertension causing right-sided heart failure, these medications relax the blood vessels going to the lungs to “unload” the heart.

Lifestyle

To help your heart work efficiently, the following lifestyle measures are important:

• not smoking
• maintaining your weight — using a home scale may be important to track weight gain caused by fluid retention
• following a balanced, low-sodium diet
• limiting fluid intake
• exercising regularly in accordance with a doctor’s advice or with the guidance of a cardiac rehabilitation specialist

Devices

For more severe cases of right-sided heart failure, you may need an implanted device to support healthy heart function.

A mechanical heart pump can take the form of a ventricular assist device or a total artificial heart to compensate for the heart’s loss of pumping strength.

In some cases, surgery may be needed to correct a congenital heart defect that caused the heart failure or repair the heart valve that is dysfunctional. Or, in the most serious cases, a heart transplant may be necessary if other treatment options have been unsuccessful.

While there are several risk factors that can lead to heart failure, there are still steps you can take to potentially help prevent it. Some things you can do include:

Right-sided heart failure is a lifelong condition, and there is currently no cure. However, many people manage symptoms and maintain a decent quality of life.

The key is to work closely with your doctor and follow your medication regimen precisely as prescribed.

It’s also critical to report any new symptoms and manage any other medical conditions that could contribute to or worsen because of heart failure. These may include:

There are advances in mechanical support devices, suggesting that treatment options will continue to save and extend lives.

Right-sided heart failure accounts for 2.2 percent of all heart failure reports. Heart failure, in general, affects 6.2 million adults in the United States.

What is the right-sided heart failure life expectancy?

Life expectancy with right-sided heart failure depends on the severity of the disease, your age, and your lifestyle choices. However, the prognosis for right-sided heart failure is typically poor.

Can left sided heart failure cause right-sided heart failure?

Yes, and the two are often linked. Left-sided heart failure results in the left ventricle having to work harder to pump blood effectively to the body — which affects the right ventricle’s ability to pump enough blood into the lungs. Most cases of right-sided heart failure are due to complications from left-sided heart failure.

Heart failure is a widespread disease, especially as a person ages.

However, specific steps and lifestyle changes may help prevent heart failure from occurring or minimize the symptoms if it does happen, such as not smoking, managing high blood pressure, and exercising regularly.

Working closely with your doctor and following your medication regimen as prescribed can help extend your life expectancy with right-sided heart failure.