Understanding Right-Sided Heart Failure

Medically Reviewed By Judith Meadows, MD, MPH
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Being diagnosed with heart failure means your heart muscles are weaker than they should be. They are not able to pump blood effectively to your body and lungs. There are different types of heart failure depending on the location and cause. The condition can be severe, but many people do well managing their condition with medications and lifestyle changes. In some circumstances, surgery is necessary. 

If you have right-sided heart failure, the right side of your heart cannot effectively pump blood. It does not mean your heart will stop beating but that the heart muscle is not pumping efficiently. 

What is right-sided heart failure? 

woman wearing heart necklace
Michela Ravasio/Stocksy United

To understand right-sided heart failure, it is helpful to know how the heart normally pumps blood. When blood returns to your heart from the veins, it comes in through the right atrium and into the right ventricle. Then it travels to the lungs for reoxygenation. Reoxygenated blood flows into the left atrium and into the left ventricle of the heart before again circulating through your body.

If the left ventricle is not pumping blood as well as it should be, it can put stress on the right ventricle pumping blood to the lungs. Eventually, the right side of the heart gets weaker and causes blood to back up into the body’s veins. 

If this happens, your body is not getting enough oxygenated blood in order to function normally. Complications can occur. 

Right-sided heart failure vs. left-sided heart failure

Right-sided heart failure usually happens because you first have left-sided heart failure and there is a backing up of blood into your body’s veins. This causes swelling in your legs and abdomen. 

Left-sided heart failure, on the other hand, causes blood to back up into the veins of your lungs, known as the pulmonary veins. This causes shortness of breath, coughing, and difficulty breathing.  

Some types of right-sided heart failure occur independently of the left side of the heart. Isolated right-sided heart failure may occur due to severe lung disease or severe disease of the blood vessels of the lungs, called pulmonary hypertension. Rarely, right-sided heart failure occurs due to congenital heart disease or abnormalities of the heart valves on the right side of the heart.

Read more about types of heart failure here.

What are the symptoms of right-sided heart failure? 

If you have right-sided heart failure, you might experience symptoms including:

When to contact a doctor 

Signs you should call your doctor include:

  • weight gain of 3 pounds or more in a day
  • swelling in your feet, ankles, or abdomen
  • feeling short of breath
  • dizziness or lightheadedness
  • confusion
  • fatigue
  • fever
  • blood-tinged mucus

What causes right-sided heart failure? 

Right-sided heart failure most often results from left-sided heart failure.

Occasionally, right-sided heart failure occurs independently of the function of the left side of the heart. A range of circumstances can cause isolated right-sided heart failure, including:

How does left-sided heart failure end up causing right-sided heart failure?

When you have left-sided heart failure, your left ventricle becomes weaker and cannot pump blood effectively to the rest of your body. As a result, the blood backs up in the vessels of your lungs. This is called pulmonary hypertension

When the left side of your heart is not working well, the right side needs to work harder. This can put a strain on the right side of the heart. In this situation, you can develop right-sided heart failure.  

Diagnosis 

Your doctor might perform several tests to diagnose right-sided heart failure.

Tests for right-sided heart failure 

  • Echocardiogram: This is an imaging test that uses sound waves to visualize your heart. It can identify damage to heart muscles. 
  • Electrocardiogram (ECG): An ECG looks at your heart’s electrical activity.
  • Chest X-ray: Chest X-rays are used to look for congestion in the heart and to determine whether the heart is enlarged.
  • Blood tests: These tests will check for electrolytes, proteins, kidney function, and certain biomarkers affecting the heart, such as brain natriuretic peptid.

In addition to testing, your healthcare professional or cardiologist will want to perform a physical exam. A cardiologist is a doctor who specializes in diseases of the heart. 

Read more about how doctors diagnose heart failure here.

Questions to ask your medical professional 

Here are some helpful questions to ask your healthcare professional about right-sided heart failure:

  • What treatment options do I have to manage my condition? 
  • What kinds of foods should I limit in order to prevent swelling?
  • How much fluid should I drink every day?
  • How can I stop my heart failure from getting worse?  

How can you treat right-sided heart failure? 

Your doctor will come up with a suitable treatment plan for you, which may involve cardiac rehabilitation and surgery.

Unlike left-sided heart failure, the treatments for right-sided heart failure are less straightforward.

The treatment is directed at the underlying causes of right ventricular dysfunction. If you have right-sided heart failure, your doctor will instruct you to manage your symptoms by taking diuretics, eating a low-salt diet, and limiting fluid intake. These treatments are advised for all people with right-sided heart failure.

Other suggested treatments are based on the most likely cause of right-sided heart failure.

Cardiac or pulmonary rehabilitation

Cardiac rehab involves a doctor-supervised program with a team of medical professionals. The program teaches certain exercises and provides education in order to live with heart failure. You are also provided counseling on medication management, decreasing stress, and improving your diet. 

Surgeries

You might need a heart transplant if other treatments are not working or if your right-sided heart failure is severe.

If the cause of your heart failure is because of a congenital heart condition, you may need surgery to fix any defects, including heart valves that are not functioning properly.  

Sometimes right-sided heart failure can occur when blood vessels in the heart become blocked. You may need surgery to open up these vessels and a stent put in place in the vessel to keep it open. 

Lifestyle changes 

There are things you can do to help manage right-sided heart failure, including

  • eating foods low in fat and sugars
  • limiting sodium to 1,500 milligrams per day
  • limiting fluids
  • weighing yourself daily and reporting a 3-pound or higher weight gain in a single day to your doctor 
  • keeping track of your blood pressure and heart rate 
  • elevating the head of your bed to prevent feeling short of breath while lying down

Other suggested treatments are based on the most likely cause of right-sided heart failure:

  • Pulmonary hypertension: This may require the use of medications, such as calcium channel blockers, that dilate the lung arteries. The use of supplemental oxygen can promote relaxation of the blood vessels of the lungs.
  • Pulmonary embolism: Blood thinners are used to prevent blood clots in the veins or lungs.

How can I prevent right-sided heart failure?

You can help prevent right-sided heart failure by taking the following steps:

  • quitting smoking if you smoke
  • exercising regularly
  • getting enough sleep
  • limiting your alcohol and caffeine intake
  • eating plenty of fruits and vegetables, whole grains, and lean proteins
  • limiting added sugars, sodium, and red meats
  • managing your stress levels 
  • managing high blood pressure and reporting concerns to your doctor

Outlook 

How well you live with right-sided heart failure depends on its cause and how severe the symptoms are. Often, you can manage heart failure with medications and by making changes to your lifestyle. However, you might require surgery.

Right-sided heart failure is a serious medical condition. It is important to keep your doctor informed of any new symptoms you are experiencing so that treatment can be adjusted right away. 

How long can you live with right-sided heart failure? 

The survival of right-sided heart failure is variable and depends on the underlying cause. There is no cure for right-sided heart failure. However, there are many medications and lifestyle changes that will limit its progression and reduce the symptoms.

Summary

Right-sided heart failure can cause swelling in your legs, fatigue, and difficulty sleeping at night.  

It is best to talk with your doctor about your diagnosis and treatment plan for heart failure. Treatment will likely be a lifelong pursuit.

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Medical Reviewer: Judith Meadows, MD, MPH
Last Review Date: 2022 Apr 25
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Albakri, A. (2018). Heart failure with reduced ejection fraction: A review of clinical status and meta-analyses of diagnosis by 3D echocardiography and natriuretic peptides-guided heart failure therapy. https://oatext.com/heart-failure-with-reduced-ejection-fraction-a-review-of-clinical-status-and-meta-analyses-of-diagnosis-by-3d-echocardiography-and-natriuretic-peptides-guided-heart-failure-therapy.php
  2. Cardiac rehab for heart failure. (2017). https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/cardiac-rehab-for-heart-failure
  3. Common tests for heart failure. (2017). https://www.heart.org/en/health-topics/heart-failure/diagnosing-heart-failure/common-tests-for-heart-failure
  4. Devices and surgical procedures to treat heart failure. (2017). https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/devices-and-surgical-procedures-to-treat-heart-failure
  5. Galiè, N. (2015). 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. https://erj.ersjournals.com/content/46/4/903
  6. Heart failure signs and symptoms. (n.d.). https://www.ucsfhealth.org/conditions/heart-failure/symptoms
  7. How can I live with heart failure? (2022). https://www.heart.org/-/media/files/health-topics/answers-by-heart/how-can-i-live-with-heart-failure.pdf)
  8. Taylor, C. J. (2019). Trends in survival after a diagnosis of heart failure in the United Kingdom 2000–2017: Population based cohort study. https://www.bmj.com/content/364/bmj.l223
  9. Types of heart failure. (2017). https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/types-of-heart-failure
  10. Types of heart failure. (2018). https://www.ncbi.nlm.nih.gov/books/NBK481485/
  11. Ram, P. (2019). Carcinoid heart disease: Review of current knowledge. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378997/
  12. Rosenkranz, S. (2020). Systemic consequences of pulmonary hypertension and right-sided heart failure. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.116.022362
  13. What is heart failure? (2022). https://www.nhlbi.nih.gov/health/heart-failure