Right-Sided Heart Failure

What is right-sided heart failure?

Right-sided heart failure is one type of heart failure. Right-sided heart failure is also called right ventricular (RV) heart failure or right heart failure.

The right side of your heart pumps “used” blood from your body back to your lungs, where it refills with oxygen. Right-sided heart failure means your heart’s right ventricle is too weak to pump enough blood to the lungs. As a result:

• Blood builds up in your veins, vessels that carry blood from the body back to the heart.
• This buildup increases pressure in your veins.
• The pressure pushes fluid out of your veins and into other tissue.
• Fluid builds up in your legs, abdomen or other areas of your body, causing swelling.

What is left-sided heart failure?

The left side of your heart pumps fresh blood to the rest of your body through your circulatory system. The left ventricle is larger and stronger than the right because it has to pump blood through your whole body.

When people have left-sided heart failure, their heart's left side has to work harder to pump the same amount of blood. Left-sided heart failure is the most common cause of right-sided heart failure.

How common is right-sided heart failure?

More than 6 million Americans have heart failure. Each year, more than 900,000 people receive a heart failure diagnosis.

Heart failure is rare in people younger than 50. With age, it becomes increasingly common. Studies have shown that around 2% of the population younger than 54 years old have heart failure. The number increases to around 8% — about 1 in 12 — for people over 75.

What causes right-sided heart failure?

Most right-sided heart failure occurs because of left-sided heart failure. The entire heart gradually weakens.

Often, left-sided heart failure results from another heart condition, such as:

• Coronary artery disease.
• High blood pressure.
• Previous heart attack.

Sometimes, right-sided heart failure can be caused by:

• High blood pressure in the lungs.
• Pulmonary embolism.
• Lung diseases such as chronic obstructive pulmonary disease (COPD).

How does left-sided heart failure cause right-sided heart failure?

People with advanced left-sided heart failure often end up with right-sided heart failure, too. When the left ventricle stops working efficiently:

1. The left ventricle pumps less blood out to the body.
2. The reduced blood flow causes blood to back up behind the left ventricle, into the left atrium, lungs and eventually the right ventricle.
3. The backup causes higher blood pressure, which damages the right side of the heart. The damaged right side stops pumping efficiently, and blood builds up in the veins.
4. As pressure increases in the veins, it pushes fluid into surrounding tissues.
5. The fluid buildup causes swelling and congestion throughout your body.

What are the symptoms of right-sided heart failure?

The main sign of right-sided heart failure is fluid buildup. This buildup leads to swelling (edema) in your:

• Feet, ankles and legs.
• Lower back.
• Gastrointestinal (GI) tract and liver (causing ascites).

Other signs include:

• Breathlessness.
• Chest pain and discomfort.
• Heart palpitations.

Where you accumulate fluid depends on how much extra fluid and your position. If you’re standing, fluid typically builds up in your legs and feet. If you’re lying down, it may build up in your lower back. And if you have a lot of excess fluid, it may even build up in your belly.

Fluid build up in your liver or stomach may cause:

• Nausea.
• Bloating.
• Appetite loss.

Once right-sided heart failure becomes advanced, you can also lose weight and muscle mass. Healthcare providers call these effects cardiac cachexia.

How is right-sided heart failure diagnosed?

To diagnose heart failure, your healthcare provider will:

• Ask you about your symptoms. Often, this can be enough for your provider to suspect heart failure.
• Perform a physical exam. Your provider will take your pulse and blood pressure, listen to your heart and lungs and look for signs of swelling.

What tests will I need to diagnose right-sided heart failure?

Your healthcare provider will test your heart function using:

• Chest X-ray.
• Electrocardiogram (EKG).
• Echocardiogram.
• Blood tests, especially to measure substances called natriuretic peptides (NPs).

To confirm a diagnosis of heart failure or rule out other conditions causing your symptoms, you may need:

• MRI.
• CT.
• Cardiac catheterization.
• Stress test.
• Nuclear exercise stress test.

Will I need a heart biopsy?

Providers rarely need to do heart biopsies to diagnose heart failure.

How is right-sided heart failure treated?

Treatment is directed at the cause of your heart failure, and not all causes of right-sided heart failure are curable. But you can treat heart failure and improve your symptoms. Often, a combination of lifestyle changes, medications and heart devices can help you manage heart failure and live an active life.

What lifestyle changes can help treat right heart failure?

Lifestyle changes can help improve your symptoms and slow the progress of the disease. Many people with mild heart failure enhance their quality of life by taking steps to:

• Quit smoking.
• Work toward a healthy weight.
• Track your daily fluid intake. You may need a diuretic medication to help get rid of extra fluid in your body.
• Eat a heart-healthy diet. A dietitian or nutritionist can help you build a healthy, filling meal plan.
• Manage stress, either through yoga, meditation or other stress management techniques.
• Get regular exercise. Talk to your provider before starting a new exercise routine if you haven’t been physically active.
• Get plenty of sleep at night.
• Follow guidelines for sexual activity for people with heart failure.

Avoid or limit:

• Alcohol.
• Caffeine.

Stay on top of your health:

• Keep track of any symptoms. If anything changes, talk to your healthcare provider.
• Monitor your blood pressure at home, in addition to regular appointments with your provider.
• Get all recommended seasonal vaccinations, such as the COVID-19, pneumonia and flu vaccinations.

How can cardiac rehab help treat heart failure?

Cardiac rehabilitation, or rehab, is a program supervised by health professionals. It can help slow the progression of heart failure. Cardiac rehab usually includes:

• Exercise training, including an activity program tailored to fit your health goals.
• Education on heart-healthy living, nutrition, medication and how to manage your condition.
• Counseling to help reduce stress.

What medications treat right heart failure?

Your provider will determine the right medication or combination of medications that will help you feel your best. These may include:

• Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) and angiotensin-receptor neprilysin inhibitors (ARNIs) to lower blood pressure.
• If (pronounced "I-F") channel blocker and beta blockers to reduce heart rate.
• Aldosterone antagonists and diuretics to get rid of excess fluid.

Your provider may also prescribe:

• Anticoagulants (blood thinners).
• Cholesterol-lowering drugs.
• Digoxin is sometimes used to treat arrhythmia (irregular heartbeat).

What devices treat right-sided heart failure?

For severe heart failure, your provider may recommend:

• Implantable cardioverter-defibrillator (ICD).
• Cardiac resynchronization therapy (CRT), a type of pacemaker.
• Left ventricular assist device (LVAD).

Will I need surgery for heart failure?

If nonsurgical methods aren’t working, your provider may talk to you about surgery for heart failure. There’s no procedure specifically for heart failure. But sometimes providers identify a problem that surgery can correct. For example, surgery can repair a problem with your heart valve or coronary artery.

Heart failure surgery options may include:

• Percutaneous coronary intervention.
• Coronary artery bypass.
• Valve replacement.
• Heart transplant.

How can I prevent right-sided heart failure?

You may not always be able to prevent heart failure. But you can sometimes treat conditions that cause heart failure.

If you treat these conditions early, you may be able to stop heart failure before it starts:

• Abnormal heart rhythms.
• Alcohol use disorder.
• Anemia.
• Coronary artery blockage.
• Heart valve disorders.
• High blood pressure.
• Obesity.
• Obstructive sleep apnea.
• Thyroid disorders.

What’s the outlook for people with right-sided heart failure?

For many people, the right combination of therapies and lifestyle changes can slow or stop the disease and improve symptoms. They can lead full, active lives.

About 1 in 10 American adults who live with heart failure have advanced heart failure. That means treatments aren’t working, and symptoms are getting worse. You may feel symptoms, such as shortness of breath, even when you’re sitting. If you have advanced heart failure, talk with your care team about important care decisions and next steps.

How do I take care of myself if I have right-sided heart failure?

The most important thing is to make healthy lifestyle habits part of your daily routine. The more you make healthy living part of your new lifestyle, the better you’ll feel. Try to:

• Work with a nutritionist or dietitian to create a nutritious, filling meal plan you can stick with long-term.
• Find an exercise routine you enjoy so you’ll be motivated to get moving every day.
• Track and manage your symptoms. Report any changes to your healthcare provider.
• Take medications as instructed.

When should I see a healthcare provider about right heart failure?

If you have chest pains or suspect you may be having a heart attack, call 911 or go to the nearest emergency room.

Get in touch with your healthcare provider if you experience:

• Shortness of breath.
• Heart palpitations, like your heart is skipping a beat or fluttering.
• Unusual fatigue or weakness.

What else should I ask my provider?

If you have right-sided heart failure, ask your provider:

• What treatment is best for me?
• Is there a special diet I should follow?
• Should I go to cardiac rehab?
• Will I need surgery?
• Will I need a heart transplant?
• What can I do to stop heart failure from progressing?
• What medications will I need?

A note from Cleveland Clinic

Right-sided heart failure means the right side of the heart can no longer pump blood efficiently. Fluid builds up in tissues, causing swelling. Treatment focuses on managing symptoms so the disease doesn’t worsen. Healthy lifestyle habits, along with cardiac rehab, improve symptoms for many people. Other treatment options include cardiac devices and surgery. If you have shortness of breath, swelling or chest discomfort, talk to your healthcare provider.