Right heart failure
Right heart failure is inability of the right ventricle to maintain output at acceptable filling pressures, most often from left heart failure or pulmonary hypertension, and acutely from pulmonary embolism or right ventricular infarction. It causes systemic venous congestion, and management centers on the underlying cause, careful volume and afterload optimization, and preload-dependent support in acute disease.
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What this article covers
- Overview
Definition: right heart failure is the inability of the right ventricle to maintain adequate output at acceptable filling pressures, producing systemic venous congestion and, when severe, low output.
- Epidemiology
Left heart failure is the most common cause of chronic right heart failure.
- Risk factors
Left heart failure and left-sided valve disease.
- Pathophysiology
Pressure overload: pulmonary hypertension or embolism raises right ventricular afterload, and the thin-walled right ventricle dilates and fails.
- Clinical features
Systemic venous congestion: elevated jugular venous pressure, peripheral edema, ascites, and a tender, pulsatile liver.
- Differential diagnosis
Left heart failure: the leading cause, with pulmonary congestion and orthopnea preceding the right-sided signs (Heart failure).
- Diagnosis
Establish clinically with echocardiography showing right ventricular dysfunction and identify the cause: the diagnostic basis is systemic venous congestion with echocardiographic evidence of right…
- Management
First-line, treat the underlying cause, continued long term: optimize left heart failure therapy, treat pulmonary hypertension, and reperfuse or anticoagulate pulmonary embolism.
- Complications
Cardiorenal and cardiohepatic syndromes. Refractory ascites and edema.
- Prognosis
Determined by the underlying cause and right ventricular recovery.
- Prevention
Treat left heart disease and pulmonary hypertension to prevent right ventricular failure.
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