Congestive heart failure - right

Alternative names
Right-sided heart failure

Definition
Right-sided heart failure is a disorder in which the right side of the heart loses its ability to pump blood efficiently, which is often a complication of other conditions.

Causes, incidence, and risk factors

Heart failure may affect the right side, the left side, or both sides of the heart. In right-sided heart failure, the right side of the heart loses its pumping action 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 heart may be unable to pump blood efficiently to the lungs.

Causes of right-sided heart failure include left-sided heart failure and chronic lung diseases (such as emphysema). Other causes include congenital heart disease, Primary pulmonary hypertension (PPH), and heart valve disease.

Right-sided heart failure occurs in approximately 5 out of 100 people.

Symptoms

     
  • Swelling of feet and ankles  
  • Urinating more frequently at night  
  • Pronounced neck veins  
  • Palpitations (sensation of feeling the heart beat)  
  • Irregular heartbeat or rapid heartbeat  
  • Fatigue  
  • Weakness  
  • Faintness

When an individual is predisposed to heart failure, sudden symptoms may be caused by any factors that impose additional demands on the heart. These factors include the following:

     
  • Increased activity  
  • Increased intake of fluids or salt  
  • Fever  
  • Infections  
  • Anemia  
  • Irregular heartbeats (arrhythmias)  
  • Overactive thyroid gland (hyperthyroidism)  
  • Kidney disease

Heart function may also worsen if you stop taking medications used to treat heart failure, such as diuretics, digoxin, ACE inhibitors, or vasodilators.

Signs and tests

Your health care provider will obtain your medical history and will conduct a physical examination. The examination may reveal the following:

     
  • Irregular or rapid heartbeat  
  • Weight gain  
  • Distended neck veins  
  • Enlarged liver  
  • Ankle swelling

Examination of the chest with a stethoscope may reveal abnormal lung sounds or abnormal heart sounds.

You may be asked to undergo some diagnostic tests:

     
  • An ECG may show signs of thickened heart muscle or arrhythmias.  
  • An echocardiogram (heart ultrasound) may show enlargement of the heart, heart abnormalities and decreased function. A Doppler study allows the health care provider to take pressure measurements in your heart and major blood vessels, which can help determine exactly what is wrong.  
  • A chest X-ray may show enlargement of the heart and lung abnormalities.  
  • Routine laboratory studies may be performed:       o CBC,       o Blood chemistry       o Urinalysis       o Thyroid function tests       o Tests for iron levels  
  • Cardiac catheterization:       o During this test, a catheter is inserted through a vein into the right side of the heart and pressures there are measured.       o Sometimes the right ventricle and the fucntioning of the right-sided valves needs to be visualized, and dye is injected into the ventricle to obtain a ventriculography.       o Your left ventricle and your coronary arteries may also need to be studied, with a coronary angiography and left ventriculography, respectively.

Treatment

Heart failure requires periodic monitoring by your health care provider. The goals of treatment include reduction of the cardiac workload, control of symptoms, and improvement of heart function. Any underlying disorders and precipitating factors should be treated, if possible

One frequent recommendation in heart failure is to decrease both the amount of dietary sodium (salt in your food) and your intake of fluids.

Specific therapies for right-sided heart failure depend on the cause of the heart failure and may include the following:

     
  • Surgery (such as to replace a valve)  
  • Interventional procedures       o Valvuloplasty       o Insertion of an implantable cardioverter defibrillator (ICD)  
  • Medications

Medications that reduce your heart’s workload include angiotensin converting enzyme (ACE) inhibitors (such as captopril or enalapril), angiotensin receptor blockers (such as losartan or candesartan), and vasodilators such as hydralazine and long-acting nitrates. Beta-blockers (such as metoprolol or carvedilol) or other medications, given in small doses, may benefit some patients.

To reduce fluid accumulation you may need to take diuretics (water pills) such as loop diuretics (furosemide or bumetanide) for moderate to severe symptoms, or thiazide diuretics (hydrochlorothiazide, chlorthalidone and chlorothiazide) for mild symptoms, or a diuretic combination. Potassium-sparing diuretics (spironolactone, triamterene) are frequently used as well to prevent excessive potassium losses.

Digitalis may be prescribed to increase the muscle contraction of the heart and help the heart pumping function during atrial fibrillation (a common arrhythmia in right-sided heart failure).

Daily aspirin is appropriate when the underlying cause of heart failure is atherosclerotic heart disease.

If your symptoms are severe, unstable or don’t improve with initial treatment, you may need hospitalization. Bed rest, reduced physical activity and intravenous medications help minimize the heart’s workload.

Long-term recommendations may include:

     
  • Weight loss  
  • Eliminating smoking and excessive alcohol consumption (both decrease the pumping efficiency of the heart)

Severe heart failure that doesn’t respond to these therapies may require heart transplantation.

Expectations (prognosis)

Heart failure is a serious disorder that carries a possibility of reduced life expectancy. There is no cure, but many forms of heart failure can be controlled with medication and correction of the underlying disorders. Heart failure may take the form of a chronic illness, and it worsens with an infection or other physical stressors.

Complications

     
  • Involvement of both sides of the heart  
  • Arrhythmias (abnormal heart rhythms)  
  • Side effects of medications       o Low blood pressure (hypotension)       o Light-headedness       o Fainting       o Headache       o GI upset       o Drug-induced arrhythmias (may be related to excess digitalis)       o Electrolyte imbalances (excess sodium or potassium in the blood)

Calling your health care provider

Call your health care provider if you notice symptoms of congestive heart failure or if you have right-sided 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 treatment of conditions that may cause congestive heart failure. Follow dietary guidelines, in particular, reduce intake of salty foods and avoid adding salt to meals. Minimize or eliminate smoking and alcohol consumption.

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.