Right-sided Heart Failure is less common than left-sided Heart Failure, yet just as lethal. Right-Sided Heart Failure puts the "congestive" back into the universal description, as described in the first Heart Failure series course, even if only as a subcategory.
Remember that the right side of the heart pumps blood to the lungs, collecting oxygen. Right-sided Heart Failure (RSHF) normally follows the development of left-sided Heart Failure (LSHF); this is why cardiologists search for LSHF first. However, it can sometimes occur on its own due to specific conditions, such as lung disease or pulmonary hypertension (Yetman, 2021; Judeo Christian, n.d.).
The right atrium receives venous (unoxygenated) blood from the systemic circulation - from the arms, head, abdomen, and legs. It receives blood that returns to the heart through the superior vena cava (draining blood from the head and upper extremities), inferior vena cava (draining blood from the abdominal viscera and the lower extremities), the coronary sinus (draining blood from the circulation of the heart muscle itself) and the many tiny Thebesian veins (draining small amounts of blood directly from the atrial vessel walls). The blood is propelled through the tricuspid valve during the right atrial systole. Then it enters the right ventricle, ejected through the pulmonic valve into the left and right pulmonary arteries. After which, it is pushed into the lungs, where the blood is replenished with oxygen (Yetman, 2021; Judeo Christian, n.d.).
Right-sided ventricular failure usually, but not always, is secondary to left-sided Heart Failure (Yetman, 2021; Judeo Christian, n.d.). The reason both the left and right ventricles tend to be affected in a domino fashion is that when the left ventricle fails, increased fluid pressure is, in effect, transferred backwards through the lungs, damaging the heart's right side. When the right side loses pumping power, blood backs up in the body's veins. This failure usually causes unsightly and medically hazardous swelling in the legs and ankles.
Right-sided ventricular failure is strongly associated with the development of systemic venous congestive symptoms. The sluggish venous congestion, in turn, leads to moderate hepatic dysfunction that is common in CHF secondary to right-sided Heart Failure.
The symptoms of right-sided Heart Failure include (Todd, 2021; Newman, 2021; HFSA, 2022):
- Fatigue
- Weight gain
- Fluid buildup/swelling in the legs and around external genitals
- Fluid buildup/swelling in the organs of the abdomen
- Abdominal fullness and discomfort
- Fluid collecting around the lungs
Be aware that these same symptoms can come from other disease processes that mimic right-sided Heart Failure. Examples include generalized volume overload, the increased systemic venous pressure in polycythemia, over-perfusion of blood products, acute renal failure with overhydration, or obstruction of either vena cava. If these conditions occur, they may readily simulate right-sided Heart Failure.
The presence of peripheral edema is not a reliable sign of HF. Another easily visible clue is the presence of observable jugular venous distention with a hepatojugular reflex. The hepatojugular reflex is an elevation of venous pressure visible in the jugular veins of the neck demonstrated when there is either active or impending right-sided Heart Failure by applying firm pressure with the flat hand over the person's liver or upper abdomen (Vaidya & Bhatti, 2021).
