The most prominent symptoms of right-sided heart failure are marked weakness, breathing difficulties, edema and ascites. Edema on the ankles (pedal edema), as well as ascites accompanied with hepatosplenomegaly are indicators of venous congestion, which is one of the main features of this condition [11]. Other symptoms may include abdominal pain, bloating, nausea and weight loss. In severe cases, where both left- and right-sided failure occurs, marked dyspnea and cyanosis may be observed. Clinical examination may reveal tachycardia, increased jugular venous pressure with sometimes visible distension, while a heart murmur may be observed during auscultation. To establish the severity of heart failure, the New York Heart Association (NYHA) classification system is used, and ranges from I (no limitations in daily or physical activity as a result of cardiac changes) to IV (symptoms occur at rest and any activity creates significant discomfort) [3].

• Splenomegaly

  This results in venous congestion, which causes hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal tract as well as peripheral edema. [sites.psu.edu]

  Clinical manifestations of right ventricular failure Clinical manifestations Hypoxemia Signs of systemic congestion  Jugular venous distension  Hepatojugular reflux  Peripheral edema  Pericardial effusion  Congestive hepatomegaly/splenomegaly  Ascites [ekjm.org]

• Leg Swelling

  When standing, swelling occurs in the feet, legs, ankles, and abdomen. When lying down, swelling may occur in the back and abdomen. If fluid accumulates in the stomach or liver, you may feel nauseous or lose your appetite. [sharecare.com]

  As a result, the body's tissues swell. The swelling most commonly affects the legs. But it also can occur in other tissues and organs. When it occurs in the lungs, it causes breathing difficulty. [drugs.com]

  swelling for many decades and dyspnoea on exertion for few months, presented to the local emergency department complaining of unexpected fall. [academic.oup.com]

  Trouble breathing not related to being active New or increased swelling of your legs or ankles Swelling or pain in your abdomen Breathing trouble at night. [fairview.org]

  According to the Mayo Clinic, right-sided heart failure is marked by swelling of the lower extremities. This swelling is caused by fluid backup in the legs, feet, and abdomen. [healthline.com]

• Anorexia

  Insufficiency -Pulmonary HTN How Right-Sided Heart Failure Happens -Increased pressure from left-sided heart failure -Increased venous congestion -Increased resistance in lungs Signs & Symptoms of Right-Sided Heart Failure -Jugular vein distention -Anorexia [quizlet.com]

  York Heart Association (NYHA) class 2 heart failure was hospitalized due to one-month history of worsening of bilateral leg edema, abdominal right upper quadrant discomfort with nausea (especially after meals), subsequent weight loss (11 pounds) and anorexia [austinpublishinggroup.com]

  Symptoms that the patient may complain about are fatigue, anxiety, depression, dependent edema of the lower extremities, anorexia and nausea (Lewis, et al, 2011). [sites.psu.edu]

  G irth of abdomen increased (from swelling of the liver and building up fluid in the abdomen)…can’t breathe well and this causes nausea and anorexia. [registerednursern.com]

  Late-stage hepatic congestion can cause symptoms (anorexia, jaundice and right upper quadrant abdominal discomfort). Signs Cyanosis and plethora. Chest markedly hyper-expanded. Laboured respiratory effort. Intercostal recession. [patient.info]

• Ankle Swelling

  Patient symptoms: Edema (swelling) in the legs and ankles Swelling of the GI tract and/or liver Impella products used during right heart failure therapies: Impella RP ® Heart Pump > [abiomed.com]

  Trouble breathing not related to being active New or increased swelling of your legs or ankles Swelling or pain in your abdomen Breathing trouble at night. [fairview.org]

  Ankle swelling. Worsening exertional dyspnoea (with deterioration in exercise tolerance). Worsening cough (particularly if non-productive). [patient.info]

  This includes exertional dyspnoea, fatigue, dizziness, ankle swelling, epigastric fullness and right upper abdominal discomfort or pain. [escardio.org]

  This causes swelling under the skin (termed peripheral edema or anasarca ) and usually affects the dependent parts of the body first (causing foot and ankle swelling in people who are standing up, and sacral edema in people who are predominantly lying [en.wikipedia.org]

• Disability

  Please enable JS and disable any ad blocker [lequotidiendumedecin.fr]

  Heart failure has a tremendous economic impact on the U.S. healthcare system because of direct medical costs, disability and loss of employment. Estimated treatment costs in 1994 were $38 billion, of which $23 billion were spent on hospitalizations. [emsworld.com]

  "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". [en.wikipedia.org]

• Leg Edema

  Cardiology (Cardiovascular Disease) Symptoms for right sided heart failure are related to fluid buildup in the body: - swelling in the feet and legs ( edema ) when standing - swelling in the back when lying down - nausea - loss of appetite Right-sided [sharecare.com]

  edema, abdominal right upper quadrant discomfort with nausea (especially after meals), subsequent weight loss (11 pounds) and anorexia. [austinpublishinggroup.com]

• Orthopnea

  Orthopnea and paroxysmal nocturnal dyspnea are related to congestion of the pulmonary blood vessels and edema of the lung tissues. [medical-dictionary.thefreedictionary.com]

  Orthopnea is the shortness of breath which occurs when blood kept in the legs by gravity returns to the chest when you lay down. Shortness of breath can also occur at night. [heartfailure.org]

  Symptoms: Dyspnea (shortness of breath due to elevated pressure in the pulmonary circulation) Orthopnea (apart from the blood that flows back into the pulmonary vessels, an additional volume of blood is orthostatically displaced into the pulmonary circulation [med-college.de]

  Orthopnea Orthopnea is an early symptom of heart failure and may be defined as dyspnea that develops in the recumbent position and is relieved with elevation of the head with pillows. [emedicine.medscape.com]

  People with severe left-sided heart failure may be short of breath when lying down (a condition called orthopnea) because gravity causes more fluid to move into the lungs. [msdmanuals.com]

• Rales

  Cardiopulmonary auscultation revealed a grade 5 systolic murmur at the apical area with axillary irradiation and discrete bilateral lung rales. [austinpublishinggroup.com]

  Signs and symptoms include shortness of breath, pitting edema, enlarged tender liver, engorged neck veins, and pulmonary rales. Heart failure accompanied by edema, such as swelling of the legs and ankles and congestion in the lungs. [icd10data.com]

  Rales heard over the lung bases are characteristic of heart failure that is of at least moderate severity. With acute pulmonary edema, rales are frequently accompanied by wheezing and expectoration of frothy, blood-tinged sputum. [emedicine.medscape.com]

  Rales or crackles, heard initially in the lung bases, and when severe, throughout the lung fields suggest the development of pulmonary edema (fluid in the alveoli ). [en.wikipedia.org]

• Sputum

  This leads to swelling in the lung tissues (pulmonary oedema) and resulting breathlessness Signs and Symptoms of LVF Severe breathlessness (sudden onset) Anxiety Cough producing frothy sputum (sometimes blood stained) Excess sweating First aid treatment [firstaidforfree.com]

  […] octurnal Paroxysmal dyspnea (awaking during sleep with extreme dyspnea) I ncreased heart rate (due to fluid overload and the heart is trying to get the blood to organs but it can’t because of muscle failure) N agging cough (can be frothy or blood-tinged sputum [registerednursern.com]

  With acute pulmonary edema, rales are frequently accompanied by wheezing and expectoration of frothy, blood-tinged sputum. The absence of rales does not exclude elevation of pulmonary capillary pressure due to LV failure. [emedicine.medscape.com]

• Nausea

  Cardiology (Cardiovascular Disease) The symptoms of right-sided heart failure include lower-extremity edema (swelling), abdominal bloating, nausea and fatigue. [sharecare.com]

  Signs and symptoms Oedema (swelling) especially in the ankles, shins or lower back Nausea & vomiting Abdominal pain and distension Lethargy and tiredness Management This is a chronic condition which needs managing by a medical professional. [firstaidforfree.com]

  […] a heart attack or severe angina, that s being treated in hospital if you have heart failure, or have had heart failure in the past if you have liver disease if you have had diabetic ketoacidosis (a complication of diabetes causing rapid weight loss, nausea [hu.glosbe.com]

  […] permanent atrial fibrillation and ischemic dilated cardiomyopathy with New York Heart Association (NYHA) class 2 heart failure was hospitalized due to one-month history of worsening of bilateral leg edema, abdominal right upper quadrant discomfort with nausea [austinpublishinggroup.com]

  Symptoms that the patient may complain about are fatigue, anxiety, depression, dependent edema of the lower extremities, anorexia and nausea (Lewis, et al, 2011). [sites.psu.edu]

• Loss of Appetite

  Cardiology (Cardiovascular Disease) Symptoms for right sided heart failure are related to fluid buildup in the body: - swelling in the feet and legs ( edema ) when standing - swelling in the back when lying down - nausea - loss of appetite Right-sided [sharecare.com]

  Loss of Appetite Fluid accumulation in the digestive organs can cause you to feel full. You may also feel bloated. You may want to try eating smaller more frequent meals instead of the traditional three large meals a day. [heartfailure.org]

  Loss of appetite results from venous engorgement and venous stasis within the abdominal organs. Prevention Prevention of heart failure mainly lies in lifestyle management. Healthy diet. [nurseslabs.com]

  Fluid accumulation in the liver or stomach can cause nausea, bloating, and loss of appetite. Severe right-sided heart failure can result in loss of weight and muscle. This condition is called cardiac cachexia. [msdmanuals.com]

• Abdominal Pain

  Signs and symptoms Oedema (swelling) especially in the ankles, shins or lower back Nausea & vomiting Abdominal pain and distension Lethargy and tiredness Management This is a chronic condition which needs managing by a medical professional. [firstaidforfree.com]

  Other symptoms may include abdominal pain, bloating, nausea and weight loss. In severe cases, where both left- and right-sided failure occurs, marked dyspnea and cyanosis may be observed. [symptoma.com]

  […] quadrant (RUQ) abdominal pain. [emedicine.medscape.com]

• Abdominal Bloating

  Cardiology (Cardiovascular Disease) The symptoms of right-sided heart failure include lower-extremity edema (swelling), abdominal bloating, nausea and fatigue. [sharecare.com]

  These include: Abdominal bloating or discomfort Persistently pale skin Poor appetite Always take chest pain seriously. Congestive heart failure, per se, usually does not cause chest pain. [emedicinehealth.com]

• Hepatomegaly

  Abdominal examination elicited pain during superficial palpation on the right upper quadrant with hepatomegaly identification, with no signs of ascites. [austinpublishinggroup.com]

  Heart Failure Happens -Increased pressure from left-sided heart failure -Increased venous congestion -Increased resistance in lungs Signs & Symptoms of Right-Sided Heart Failure -Jugular vein distention -Anorexia -N/V -Abdominal distention -Ascites -Hepatomegaly [quizlet.com]

  Ultrasound examination of abdomen showed congestive hepatomegaly. 2D Echocardiography showed a homogenous, irregular, fimbriated mass measuring 33 x 20 mm in RV outflow, attached to pulmonary valve, causing RV outflow obstruction ( Figure 1 ). [pubs.sciepub.com]

  Patients also may suffer from hepatomegaly. This refers to enlargement of the liver. This occurs due to venous congestion of the liver itself which causes swelling of the entire organ. [sharecare.com]

  May manifest as hepatomegaly. Cardiac Remodeling Atrial Fibrillation: Due to dilation of the right atrium Tricuspid Valve Regurgitation : May occur in a late stage due to dilation of the right ventricle. [pathwaymedicine.org]

• Jaundice

  Jaundice in advanced cases. Ascites in advanced cases. Peripheral pitting oedema. Differential diagnosis Primary pulmonary hypertension (can be considered a cause of cor pulmonale). Pulmonary valve stenosis. [patient.info]

  Significant liver congestion may result in impaired liver function ( congestive hepatopathy ), and jaundice and even coagulopathy (problems of decreased or increased blood clotting) may occur. [en.wikipedia.org]

• Heart Failure

  Abstract The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. [ncbi.nlm.nih.gov]

  Right Heart Failure According to authors of an April 2008 article in "Circulation," left heart failure is the most common cause of right heart failure. [livehealthy.chron.com]

• Hypertension

  Primary pulmonary hypertension carries a grim prognosis, therefore, it is imperative that prior to reaching this diagnosis, a thorough search be made for all possible causes of pulmonary hypertension. [ncbi.nlm.nih.gov]

  WHO Classification of Pulmonary Hypertension Pulmonary arterial hypertension Pulmonary venous hypertension Pulmonary venous hypertension associated with hypoxaemia (eg COPD) Pulmonary hypertension due to chronic thrombotic or embolic disease Miscellaneous [rcemlearning.co.uk]

  Pulmonary hypertension, like arterial hypertension, is a phenomenon of diverse causes that include both increases in flow and in resistance across the pulmonary vascular bed. [onlinejacc.org]

• Tachycardia

  A 44-year-old patient, with personal history of AIDS, was referred to our emergency unit with tachycardia and moderate signs of right-sided heart failure. [ncbi.nlm.nih.gov]

  […] congestion -Increased resistance in lungs Signs & Symptoms of Right-Sided Heart Failure -Jugular vein distention -Anorexia -N/V -Abdominal distention -Ascites -Hepatomegaly -Dependent edema, peripheral edema -Weight gain -Signs of left-sided heart failure -Tachycardia [quizlet.com]

  NURSING ASSESSMENT Auscultation When auscultating the client’s heart you may hear tachycardia and murmurs. When listening to lung sounds you may hear crackles, rhonchi and even wheezes. You may also notice they are tachypneic (Lewis, et al, 2011). [sites.psu.edu]

  Clinical examination may reveal tachycardia, increased jugular venous pressure with sometimes visible distension, while a heart murmur may be observed during auscultation. [symptoma.com]

  Arrhytmias Bradycardia/tachycardia Compensated and decompensated heart failure The body reacts to the reduced cardiac output with different mechanisms to compensate for the reduced output. [med-college.de]

• Vascular Disease

  […] hypoxemia and pulmonary thromboembolic and venoocclusive disease, collagen vascular disease, portal hypertension, HIV infection as well as pulmonary hypertension secondary to drugs and toxins. [ncbi.nlm.nih.gov]

  However, the prevalence of PH is thought to be much higher than reported in developing countries where diseases that may promote pulmonary vascular disease (schistosomiasis, sickle cell disease, human immunodeficiency virus infection, liver cirrhosis [rcemlearning.co.uk]

  In fact, left-heart failure is the most common cause of right-sided heart failure, while congenital heart disease, infection of heart valves (endocarditis), vascular diseases such as hypertension, myocardial infarction (heart attack) and numerous other [symptoma.com]

  Anatomical disruption of the pulmonary vascular bed due to primary lung disease (for example, in emphysema, pulmonary thromboembolic disease and pulmonary fibrosis). [patient.info]

  Dyslipidemia Coronary/peripheral vascular disease Sleep-disordered breathing Collagen vascular disease, rheumatic fever Pheochromocytoma Thyroid disease Substance abuse (previous/current history) History of chemotherapy/radiation to the chest The New [emedicine.medscape.com]

• Cardiomegaly

  Chest x-ray did not show additional changes besides those previously known such as cardiomegaly. Electrocardiogram showed atrial fibrillation with a normal heart rate. Brain natriuretic peptide was 690 ng/L. [austinpublishinggroup.com]

  Cardiomegaly is a nonspecific finding that nonetheless occurs in most patients with chronic heart failure. [emedicine.medscape.com]

  In a person who is compensated, this may show cardiomegaly (visible enlargement of the heart), quantified as the cardiothoracic ratio (proportion of the heart size to the chest). [en.wikipedia.org]

• Dizziness

  We present a case of a 76-year-old man, known to have cardiac failure on regular treatment who presented with predominant features of right-sided heart failure accompanied with dizziness. [ncbi.nlm.nih.gov]

  Fatigue and dizziness - because less blood is reaching the organs of the body, it can cause feelings of weakness. Because less blood is reaching the brain is can also cause dizziness and confusion. [medicalnewstoday.com]

  Call 911 or your local emergency services right away if you have these symptoms : crushing chest pain discomfort in the chest, such as squeezing or tightness discomfort in the upper body, including numbness or a coldness excessive fatigue dizziness rapid [healthline.com]

  This includes exertional dyspnoea, fatigue, dizziness, ankle swelling, epigastric fullness and right upper abdominal discomfort or pain. [escardio.org]

  Compromise of left ventricular forward function may result in symptoms of poor systemic circulation such as dizziness, confusion and cool extremities at rest. [en.wikipedia.org]

• Nocturia

  […] resistance in lungs Signs & Symptoms of Right-Sided Heart Failure -Jugular vein distention -Anorexia -N/V -Abdominal distention -Ascites -Hepatomegaly -Dependent edema, peripheral edema -Weight gain -Signs of left-sided heart failure -Tachycardia -Fatigue -Nocturia [quizlet.com]

  Symptoms that the patient may complain about are weakness, fatigue, anxiety, depression, shortness of breath, shallow, fast respirations, dry, hacking cough, nocturia and paroxysmal noctural dyspnea (Lewis, et al, 2011). [sites.psu.edu]

  D: Nocturia is not present in heart failure. 4. Answer: A. Stage I A: Stage I refer to a patient who reports no symptoms of heart failure at rest but becomes symptomatic with increased physical activity. [nurseslabs.com]

  Nocturia and oliguria Nocturia may occur relatively early in the course of heart failure. Recumbency reduces the deficit in cardiac output in relation to oxygen demand, renal vasoconstriction diminishes, and urine formation increases. [emedicine.medscape.com]

  Nocturia (frequent nighttime urination) may occur when fluid from the legs is returned to the bloodstream while lying down at night. [en.wikipedia.org]

• Renal Insufficiency

  Causes of constrictive pericarditis included idiopathic (52%, n = 36), tuberculosis (9%, n = 6), postcardiotomy (12%, n = 8), radiation (4%, n = 3), renal insufficiency (12%, n = 8), and autoimmune disease (12%, n = 8). [ncbi.nlm.nih.gov]

  However, rapid and excessive diuresis may precipitate systemic hypotension and renal insufficiency (1). Spironolactone, an aldosterone antagonist that is of benefit in patients with left-heart failure, is also used to treat right-heart failure (1). [rcemlearning.co.uk]

  The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol. 2000 Mar 1. 35 (3):681-9. [Medline]. [emedicine.medscape.com]

A thorough clinical examination and a good patient history may provide vital clues that determine the course of workup in these patients. Initial studies should comprise ECG, chest X-ray and laboratory studies including CBC, liver and kidney function tests, serum electrolytes and brain natriuretic peptide (BNP). If the symptoms appeared abruptly, cardiospecific enzymes should be evaluated as well. Chest X-ray may reveal pulmonary edema or an increased cardiac silhouette, whereas ECG studies provide a good view into the cardiac conduction system. To make a definite diagnosis, echocardiography is the optimal imaging study, which provides an excellent view into the cardiac structures [12]. Additional techniques that may be of use to establish the overall condition of the patient are CT and MRI, while 3D echocardiography is showing promising results in replacing invasive methods for determination or right atrial pressure [13].

• Pericardial Effusion

  We present this case to highlight the importance to consider that a large, solitary, right atrial mass in conjunction with pericardial effusion in a patient with HIV infection should lead to consider, as soon as possible, the diagnosis of lymphoma. [ncbi.nlm.nih.gov]

  Vasavada Scleroderma pericardial disease presented with a large pericardial effusion -a case report Angiology, 52 (2001), pp. 59-62 [13.] G. Peronato, P. De Sandre, M. Podswiadek, S. Arfiero, L. [reumatologiaclinica.org]

  Clinical manifestations of right ventricular failure Clinical manifestations Hypoxemia Signs of systemic congestion  Jugular venous distension  Hepatojugular reflux  Peripheral edema  Pericardial effusion  Congestive hepatomegaly/splenomegaly  Ascites [ekjm.org]

To effectively treat right-sided heart failure, resolution of the underlying cause is a must [1]. During the diagnostic workup, however, symptomatic therapy and correction of blood pressure and tissue oxygenation must be carried out, usually with the help of various pharmacologic agents. Digoxin, β-blockers, calcium-channel antagonists, diuretics, ACE inhibitors, aldosterone blockers and several other groups are all used under various circumstances [3]. Changes in dietary habits may be of particular importance, especially reduction in sodium intake, as it is shown to be a very important factor in the pathogenesis of atherosclerosis and other cardiovascular diseases, including MI. Directed therapy may be initiated in the case of endocarditis, where various antibiotic regimens exist, depending on the underlying pathogen, while congenital heart disease is usually treated surgically. Thrombolytic therapy is indicated in the setting of pulmonary embolism, whereas invasive cardiac surgery is required for patient with MI. Sometimes, despite after recommended treatment, heart failure may persist and require implantation of various devices. Defibrillators or pacemakers may be inserted and are used as a last resort in treating heart failure.

The outcome of patients with right-sided heart failure is not good, since its presence is shown to correlate with a poor prognosis [8]. A 50% overall mortality rate 4 years after making the diagnosis shows how dangerous heart failure is [6]. Mortality rates significantly depend on the underlying condition, however, since some diseases can be almost completely cured and pathophysiologic changes in the right heart can be almost fully reversed.

Causes of right-sided heart failure may be numerous, but the most common is left-sided heart failure, which puts immense pressure on the pulmonary vasculature and consequently on the right ventricle. Other causes include [5] [6]:

• Lung diseases - Chronic obstructive pulmonary disease (COPD), pulmonary embolism, cystic fibrosis, as well as chest wall dysfunction all lead to development of pulmonary edema and profound hypertension, thus creating conditions for cor pulmonale.
• Cardiovascular disease - Hypertension, coronary artery disease (CAD) and myocardial infarction (MI) can cause significant changes in blood flow and oxygen delivery into cardiac myocytes and cause rapid heart failure.
• Cardiomyopathies - Restrictive, dilatative and and hypertrophic cardiomyopathy exert marked changes on the right ventricle and often lead to heart failure.
• Valvular heart disease - In the setting of tricuspid or pulmonic stenosis, usually as a result of endocarditis, significant effort by the right heart is needed to achieve adequate output when combating increased resistance through the affected valves.
• Congenital heart disease - Ebstein malformation and right-to-left shunts such as tetralogy of Fallot and transposition of great arteries cause significantly higher pressures in the right ventricle.
• Endocrine disorders - Thyroid abnormalities, adrenal insufficiency, pheochromocytoma and diabetes mellitus are also known to be involved as causes of heart failure.

Various other factors, including iatrogenic, nutritional (obesity, selenium or thiamine deficiency), environmental (heavy alcohol consumption), infectious (Chagas disease), end-stage renal disease and several other have shown their properties in initiating heart failure [5].

Because of significant advances in medical care that have enabled a longer life expectancy, incidence and prevalence rates of heart failure have risen in the past few decades [5]. Rough estimates suggest that the prevalence rate of heart failure in general is between 1-2% in countries of the Western world, while an incidence rate is established to be approximately 5-10 per 1000 individuals [7]. Prevalence rates are shown to rise abruptly after 70 years, showing that between 10-20% of individuals over 70 years develop heart failure, indicating that advanced age is a significant factor [6]. In the United States, approximately 5 million individuals are affected by this condition and incidence rates indicate that more than 500,000 cases occur every year [3]. Exact prevalence rates of right-sided heart failure are not formed yet, but it is one of the most important predictors of mortality in heart failure [8]. Namely, heart failure that is caused by MI and several other causes has substantially different outcomes depending on the presence or absence of right-sided heart failure [8].

The pathogenesis of right-sided heart failure is complex and various pathological events occur simultaneously. Through the inferior vena cava and the portal vein, the venous circulation drains into the right atrium. During diastole, blood is pooled into the right ventricle and then forced into the pulmonary circulation during systole. Depending on the underlying condition that affects the right heart, various mechanisms contribute to eventual failure. In the case of MI, sudden cessation of blood flow leads to hypoxia, myocardial necrosis and fibrosis, thus reducing the viability of myocardial cells to perform their function. In endocarditis, stenosis of pulmonary or tricuspid valve necessitates a greater contractile force to combat higher resistance. Pulmonary hypertension, however, is one of the most significant factors in the development of right-sided heart failure, which occurs in the setting of left-sided heart failure and various lung diseases [9]. The right heart is unable to overcome increased resistance in the pulmonary vasculature and the end-result, regardless of the cause, is inadequate tissue oxygenation and diffuse hypoxia. In order to restore adequate oxygen supply to tissues, various compensatory mechanisms are activated. Cardiac remodeling, increased oxygen extraction from tissue, changes in systemic circulation and hormonal stimulation are some of the most important [3]. Right ventricular hypertrophy and dilation occurs to maximize output, while upregulation of sympathetic tone results in increase heart rate. The renal system triggers the renin-angiotensin-aldosterone system that contributes by retention of salt and water. However, all of these effects can cause significant damage to the heart if the condition that led to activation of these mechanisms is not resolved. More importantly, the right heart is not able to sustain such powerful stimulation for longer periods [10]. Over time, progressive deterioration of right heart function, leading to irreversible fibrosis of myocytes with both systolic and diastolic dysfunction.

Various steps can be made to prevent the onset of heart failure. Firstly, proper management of various conditions that may precipitate heart failure is vital, while dietary habits that include low sodium intake may significantly reduce the risk for developing cardiovascular diseases in general. The diagnosis of heart failure in early stages is proven to significantly prolong survival, which is why a thorough workup by the physician may ultimately save a patient's life.

Right-sided heart failure is a clinical entity that occurs as a result of various conditions that impair right heart function, resulting in reduced output and volume overload [1]. Left-sided heart failure is the most common cause, most likely as a result of pulmonary edema, eventually leading to an acute right heart failure known as cor pulmonale. Myocardial infarction, endocarditis affecting either tricuspid or pulmonary valves, congenital heart disease (right-to-left shunts), Ebstein malformation, as well as various forms of cardiomyopathy have all been described as precipitating factors of right-sided heart failure [2]. Under physiological circumstances, the entire venous system is drained into the right atrium, from where it travels into the right ventricle and eventually into the pulmonary circulation. Abnormalities in pulmonary circulation (such as hypertension as a result of left-heart failure), deficient right ventricle contractility (cardiomyopathy, endocarditis) and impaired either systolic and/or diastolic function of the right heart leads to reduced cardiac output and tissue oxygenation [3]. Because hypoxia of various organs may occur, several compensatory mechanisms are activated, including dilation and hypertrophy of the right ventricle, activation of the sympathetic system that results in increased contractility and heart rate acceleration, salt and water retention from the kidneys and blood flow changes [4]. However, as the cause is either not resolved or the onset of heart failure is acute and sudden, these compensatory mechanisms cause more harm than benefit, which may lead to irreversible changes in cardiac myocytes, mainly apoptosis, collagen deposition and fibrosis of the cardiac muscle. In the case of right-sided heart failure, the end-result is reduced movement of venous circulation that leads to congestion, portal hypertension, development of ascites and hepatosplenomegaly. Consequently, one of the main clinical presentations of patients with right-sided heart failure is peripheral edema, especially of the extremities and ankles (known as pedal edema), usually accompanied with diffuse weakness and dyspnea. Because of venous congestion in the gastrointestinal system, abdominal discomfort, bloating and weight loss may be reported as well. Clinical examination may reveal tachycardia (and in case of endocarditis, a heart murmur may be noted on auscultation), lower oxygen saturation, enlarged liver and spleen and elevated jugular venous pressure. Workup should include laboratory studies such as complete blood count (CBC), liver transaminases, cardiospecific enzymes (in case symptoms appeared abruptly), urine function tests (blood urea nitrogen and creatinine), serum electrolytes, brain natriuretic peptide levels and albumin count. Plain radiography is a simple and easy diagnostic method that may identify signs of heart failure, while electrocardiography (EKG), echocardiography, computed tomography (CT) and magnetic resonance imaging (MRI) are useful techniques to identify the underlying cause responsible for heart failure. Treatment is aimed at resolving the condition that caused heart failure, but it is not always possible. Symptomatic therapy, dietary changes and in some cases, device implantation is necessary. Heart failure has a poor prognosis if the disease that caused it is not treated. For these reasons, finding the cause is imperative in achieving good outcomes.

Right-sided heart failure is a clinical syndrome that describes failure of either the right atrium and/or right ventricle as a result of various diseases. It may occur as a separate condition, where marked changes in structure of these heart chambers are observed, or it may occur together with left-sided heart failure. In fact, left-heart failure is the most common cause of right-sided heart failure, while congenital heart disease, infection of heart valves (endocarditis), vascular diseases such as hypertension, myocardial infarction (heart attack) and numerous other conditions may trigger this pathological event. Right-sided heart failure often develops as a result of increased pressures in the blood vessels of the lungs (known as pulmonary hypertension), where the right heart should pump blood that arrived from all the veins in the body. Additionally, various conditions within the right heart can significantly harden its function. The end-result is a need for increased effort of the right heart to pump the blood into the lungs, which is achieved by activating several compensatory mechanisms. The heart enlarges its chambers and increases muscle size and strength, neural networks that increase the velocity and the strength of the heart are stimulated and the kidneys attempt to decrease blood flow through them while savoring water and salts to compensate for blood pressure changes. These actions are effective in short-term circumstances, but since heart failure is considered to be the end-stage disease of the heart, these mechanisms persist for a prolonged period of time and eventually start to actually harm the individual and cause further deterioration.

Once right-sided heart failure occurs, the main feature is reduced velocity of blood flow through the venous system, manifesting as swelling of the extremities, particularly ankles, liver and spleen enlargement, together with extreme fatigue that occurs due to insufficient oxygen delivery by the damaged heart. To make the diagnosis, various imaging and laboratory studies need to be carried out. Chest X-ray, electrocardiography and often echocardiography are required, while various blood tests including serum electrolytes, liver and kidney function tests, as well as levels of proteins in blood are necessary to evaluate the status of various organs. It is important to find the underlying disease that is responsible for right-sided heart failure, as treatment success solely depends on managing the cause.

Depending on the condition responsible, various therapeutic approaches exist. Usually, symptomatic management is necessary in initial stages before the cause is determined, after which directed treatment may be initiated. Various drugs, surgical procedures and implantation of devices that assist in normal cardiac functioning serve as appropriate treatment modalities. It is estimated that more than 5 million people in the United States suffer from heart failure and more than 500 000 new cases occur every year. Moreover, it was observed that approximately 2-3% of people in the Western world have this condition, with the majority being over 75 years of age. When taking into consideration the fact that the survival rate 4 years after the diagnosis of heart failure is 50%, the significance of this condition must not be undermined. In fact, an early diagnosis of the underlying condition may be lifesaving for the patient, but much can be done in terms of prevention. Reduced sodium intake through diet, cessation of heavy alcohol consumption and smoking (well-known factors for atherosclerosis) and ensuring long-term patient care can reduce the burden of this condition in a significant manner worldwide.

1. Kholdani CA, Fares WH. Management of Right Heart Failure in the Intensive Care Unit. Clin Chest Med. 2015;36(3):511-512.
2. Pazos-López P, Peteiro-Vázquez J, Carcía-Campos A, García-Bueno L, de Torres JPA, Castro-Beiras A. The causes, consequences, and treatment of left or right heart failure. Vascular Health and Risk Management. 2011;7:237-254.
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