Congestive heart failure - right-sided

Definition

Right-sided heart failure is a condition in which the right side of the heart loses its ability to pump blood efficiently.

Alternative Names

Causes

Right-sided heart failure occurs in about 1 in 20 people. Coronary artery disease is the most common cause of heart failure in the United States, but it can be a complication of other conditions.

Heart failure may affect the right side of the heart (right ventricle), the left side (left ventricle), or both sides. 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.

Symptoms

• Shortness of breath
• Swelling of feet and ankles
• Urinating more frequently at night
• Pronounced neck veins
• Palpitations (sensation of feeling the heart beat)
• Irregular fast heartbeat
• Fatigue
• Weakness
• Fainting

A variety of different situations may trigger an episode of heart failure, including:

• Increased intake of fluids or salt
• Fever
• Infections
• Anemia
• Blockage in the coronary arteries
• Irregular heartbeats (arrhythmias)
• Overactive thyroid gland (hyperthyroidism)
• Kidney disease

Many people admitted to the hospital with heart failure do not follow a recommended low-salt diet or take heart failure medicines as prescribed.

Exams and Tests

Your health care provider will conduct a physical examination, which may reveal:

• Abnormal heart sounds
• Abnormal lung sounds
• Murmurs
• Irregular or rapid heartbeat
• Weight gain
• Distended neck veins
• Enlarged liver
• Ankle swelling

Heart failure patients may undergo some of the following common tests:

• An ECG, to look for 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, to look for enlargement of the heart and fluid accumulation in the lungs.
• An echocardiogram (heart ultrasound) and a Doppler study, which may show heart chambers enlargement, leaky valves, and poor pumping function.

The following lab tests may be performed:

• CBC
• Blood chemistry
• Liver function tests
• Urinalysis
• Thyroid function tests
• B-Type Natriuretic Peptide (BNP)

Cardiac catheterization may be performed. In right heart catheterization, a catheter is inserted through a vein into the right side of the heart to measures the pressures. Sometimes, an injection of contrast material ("dye") in the right ventricle is necessary to help understand the problem (right ventriculography).

The left ventricle and arteries in a similar fashion.

Treatment

Heart failure requires periodic monitoring by your health care provider. The goals of treatment include controlling the symptoms, reducing the heart's workload, 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 such as bypass surgery (CABG) and angioplasty are the solution for some people.

LIFESTYLE

Generally, you must reduce the salt in your food and the amount of liquids you drink. You should also consider losing weight if you are overweight, stopping smoking, and avoiding too much alcohol.

MEDICATION

Diuretics (water pills) can help reduce fluid accumulation. Furosemide or bumetanide can help moderate to severe symptoms. Hydrochlorothiazide, chlorthalidone, and chlorothiazide 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 metoprolol 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 a biventricular pacemaker, which helps both ventricles contract at the same time (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

A patient with severe heart failure that does not respond to these therapies may require a heart transplant.

Outlook (Prognosis)

Heart failure is a serious disorder. Everything possible should be done to prevent the heart's pumping problems from getting worse.

There is no cure, but many forms of heart failure can be controlled with medication, addressing the underlying disorders, and using implanted devices with defibrillation capabilities.

Possible Complications

• Arrhythmias (abnormal heart rhythms), which may be life-threatening
• Fainting
• Repeat hospitalizations
• Side effects of heart failure medications

When to Contact a Medical Professional

Call your health care provider if you notice symptoms of congestive heart failure and your symptoms change, worsen, or do not improve with treatment.

Also call if chest pain, weakness, fainting, rapid or irregular heartbeat, sudden weight gain, swelling, or other new or unexplained symptoms develop.

Prevention

Follow your health care provider's recommendations for treating conditions that may cause congestive heart failure