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.
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 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.
If you have right-sided heart failure, you might experience symptoms including:
- leg and ankle swelling
- abdominal swelling that can also affect the liver, known as ascites
- shortness of breath
- feeling tired or weak
- frequent urination or reduced urination
- confusion
- loss of appetite or feeling full without eating a lot of food
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
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:
- high blood pressure in your lungs, known as pulmonary hypertension
- pulmonary embolism, when a blood clot blocks blood flow to the vessels in the lungs
- certain lung diseases, such as chronic obstructive pulmonary disorder
- being born with certain heart conditions, including atrial septal defect and abnormal heart vessels
- heart tumors, as they are typically located on the right side of the heart
- right-sided valve abnormalities
- cardiomyopathies affecting the right ventricle, such as myocarditis or Epstein’s anomaly
- ventricular cardiomyopathy
- myocardial infarction of the right ventricle
- complications following cardiac surgery
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.
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?
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.
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
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.
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.
