What is Right-Sided Heart Failure?

Right-sided, or right ventricular, heart failure is defined as a process, not a disease. This condition is also known as cor pulmonale. It often occurs when the weakened and/or stiff left ventricle loses the ability to efficiently pump blood to the rest of the body. As a result, fluid is forced back through the lungs, weakening the heart’s right side, and causing right-sided heart failure. This backward flow backs up in the veins, causing fluid to swell in the legs, ankles, GI tract and liver. Right-sided heart failure is also known as cor pulmonale or pulmonary heart disease.

Signs and Symptoms 

Signs and symptoms of right-sided heart failure can range from mild to severe. A physician can determine if any of the following indications of heart failure are being caused by cor pulmonale:

• Awakening at night with shortness of breath
• Shortness of breath during exercise or when lying flat
• Coughing
• Wheezing
• Difficulty concentrating
• Dizziness
• Fatigue
• Fluid retention causing swelling in the ankles, legs, feet and/or abdomen
• Increased urge to urinate
• Lack of appetite and nausea
• Difficulty exercising
• Sudden weight gain

If any of these right-sided heart failure symptoms occur, call 9-1-1 immediately. Don’t self- diagnose; allow a medical professional to determine if you are experiencing a life-threatening event.

• Sudden shortness of breath while experiencing a chest pain, a rapid or irregular heartbeat or fainting
• Coughing up white or pink phlegm while experiencing severe shortness of breath
• Severe weakness
• Fainting
• Rapid or irregular heartbeat
• Chest pain caused by a heart attack 

Causes

Right-sided heart failure is almost always caused by a problem with the left side of your heart. When the left ventricle fails, excess fluid pressure flows back through the lungs, eventually damaging the right side of your heart. In comparison, left-sided heart failure is most frequently caused by persistent high blood pressure, coronary artery disease, or a heart attack. 

Right-sided heart failure causes can include:

• Cocaine use
• Coronary artery disease
• Diabetes
• Heavy alcohol use
• High blood pressure
• Obesity
• Pulmonary edema
• Pulmonary embolism
• Pulmonary hypertension
• Pulmonic stenosis
• Sleep apnea
• Tobacco use

In other cases, certain lung diseases like COPD or pulmonary fibrosis can cause right-sided heart failure, despite the left side of the heart functioning normally.

Risk Factors

Right-sided heart failure risk factors can include:

• Age: Men between the ages of 50-70 often experience right-sided heart failure if they have previously suffered a heart attack.
• Congenital heart defects: Structural heart defects may prevent proper blood circulation from the heart.
• Chronic diseases: Lung conditions like COPD or pulmonary fibrosis, diabetes, HIV, chronic heart disease, hyperthyroidism, hypothyroidism, or a buildup of iron or protein can lead to right-sided heart failure.
• Irregular heartbeats: Abnormal heart rhythms, especially if they are very frequent and fast, can weaken the heart muscle.
• Left-sided heart failure: The weakened and/or stiff left ventricle of the heart does not pump blood efficiently throughout the body. This causes fluid pressure to build up and eventually damage the right side of the heart.
• Left-to-right shunt: An abnormal connection between the right and left sides of the heart causes blood volume of the right ventricle to overload.
• Lung conditions: Blood clots in the lungs or high blood pressure in the lungs can increase the risk of right-sided heart failure.
• Pericardial constriction: Inflammation causes the pericardium (a sac covering the heart) to scar, thicken and tighten the heart muscle.
• Previous heart attack: Damage to the heart muscle may affect its ability to pump blood effectively.
• Race: African-American men are at higher risk than others for developing right-sided heart failure.
• Some chemotherapy and diabetes medications: Certain drugs have been found to increase the risk of right-sided heart failure.
• Valvular heart disease: Damage or a defect in one of the four heart valves can prevent the heart from pumping blood effectively.
• Viral infection: Certain viral infections can damage the heart muscle.

Diagnosis

To determine if a patient has right-sided heart failure, we use advanced technology to diagnose, inform treatment and carefully monitor the condition effectively. Diagnostic procedures and technologies can include:

• Blood tests: These tests can measure substances that are elevated in people with heart failure, and check kidney, liver and thyroid function and look for signs of other diseases that affect the heart.
• Cardiac CT Scan: X-rays and computers are used to create images of the heart. This provides a more detailed picture than an ultrasound.
• Chest X-ray: A common imaging test to view the heart and lungs. The test can show whether the lungs
• Cardiac catheterization: A long, thin flexible tube is threaded through a blood vessel in the arm or groin and to the heart. Contrast material is injected through the tube and a type of X-ray movie is taken to show blockages in the heart. This procedure may be done along with a coronary angiography.
• Coronary angiography: During the procedure, a dye that can be seen on an X-ray is injected into the heart chambers or coronary arteries. The dye lets a physician study blood flow through the heart and blood vessels to detect any blockages. This procedure may be done along with a cardiac catheterization.
• Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves.
• Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged or overworked. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.
• Myocardial biopsy: A long, thin flexible tube is threaded through a blood vessel in the arm, groin or neck and into the heart to remove a small piece of the heart muscle. This heart tissue is studied under a microscope to determine whether heart disease is present that causes right-sided heart failure.
• Pulmonary functions studies: During these tests, you will breathe in and out of a tube that is connected to a measuring device. The device shows how well you can move air in and out of your lungs.
• Stress testing: This test is conducted during exercise to make the heart work hard and beat fast while heart tests are done. If a patient can’t exercise, medicine is given to increase heart rate. Used along with an EKG, the test can show changes to the heart’s rate, rhythm or electrical activity as well as blood pressure.

Prevention

While you cannot prevent all risk factors associated with right-sided heart failure, you can take steps to lower your risks for diseases or conditions that can cause or complicate cor pulmonale.

• Balance your blood sugar: If you have diabetes, watch what you eat and check your blood glucose regularly. Talk to your physician about medications that control blood sugar spikes.
• Be active: Moderate exercise helps circulation and decreases stress on your heart muscle.
• Eat a healthy diet: Limit sugar, saturated fat, cholesterol and salt, and eat plenty of fruit, vegetables, whole grains and low-fat dairy products.
• Get regular checkups: And, if you experience new or changing symptoms or side effects from medications, see your physician.
• Maintain a healthy weight: Losing weight and maintaining a healthy weight puts less stress on the heart.
• Manage sleep apnea: If you have sleep apnea, use a CPAP/ BIPAP device every night.
• Reduce stress: Stress can contribute to a fast or irregular heartbeat.
• Reduce your alcohol intake: In some cases, you may need to stop drinking entirely. If you can drink, keep your intake low.
• Stop smoking: Smoking damages blood vessels, raises blood pressure, reduces the amount of oxygen in the blood and makes the heart beat faster.
• Take your medications as prescribed: If you’ve been prescribed a medication for congestive heart failure or a causative condition, be sure to take it as prescribed. 

Treatment and Recovery

Treatment for cor pulmonale focuses on managing symptoms and treating underlying causes of the condition. A right-sided heart failure treatment plan may include medications, lifestyle changes, devices and/or surgery. Depending on the severity of the condition, treatment can include:

Medications

Medications are prescribed to improve cardiac function, and treat symptoms like heart rate, high blood pressure and fluid buildup to:

• Reduce fluid retention and the loss of potassium
• Open narrowed blood vessels to improve blood flow
• Reduce blood pressure and slow a rapid heart rhythm
• Increase blood flow throughout the body and reduce swelling
• Reduce fluid by promoting urination
• Prevent blood clots
• Lower cholesterol

Your doctor may prescribe specific types of medications:

• Beta-blockers—These medications slow down your heartbeat so that your heart does not work as hard.
• Diuretics—These medications help eliminate sodium and surplus fluid in your body.
• Pulmonary vasodilators—These medications relax the blood vessels connected to your heart and lungs.
• Digoxin—This medication increases your heart’s ability to pump.
• Vasodilators—These medications relax your blood vessels and stop chemicals from weakening your heart.

Lifestyle Changes

A few lifestyle changes can improve the quality of life and right-sided heart failure symptoms. It is essential to follow a low-sodium, low-fat and low-cholesterol diet. Gentle aerobic exercise is also recommended.

Surgery and Other Procedures

If medications are not effective in managing right-sided heart failure, or if symptoms are severe, a ventricular-assist device implant or a heart transplant, may be necessary.

• Ventricular assist device (VAD) surgery: This device can be implanted to help a weak heart pump more efficiently.
• Heart transplant surgery: This surgery is done when all other right-sided heart failure treatments have failed. The damaged heart is surgically removed and replaced with a healthy heart from a deceased donor.

Prognosis

The prognosis for right-sided heart failure varies, depending on the cause of the condition and severity of the symptoms. Some will improve with treatment and lifestyle changes. For others, cor pulmonale can be life-threatening; and severe symptoms may require a heart transplant or implant of a ventricular assist device.

Complications

Complications of right-sided heart failure can include:

• Angina: Chest, jaw, neck discomfort or pressure is caused by the lack of blood flowing to the heart.
• Atrial fibrillation: This irregular heart rhythm can increase the risk of stroke and blood clots.
• Cardiac cachexia: This unintentional weight loss of at least 7.5 percent of normal weight within six months can be life-threatening without supplemental nutrition.
• Heart valve issues: Increased pressure on the heart can disrupt blood from flowing in the right direction throughout the heart.
• Heart attack: The heart muscle is damaged permanently by the lack of blood flow to the heart for an extended period.
• Impaired kidney function: Decreased kidney function is common in patients with right-sided heart failure. If the kidneys receive less blood, kidney failure requiring dialysis treatment can occur.
• Liver damage: Fluid backing up from the heart puts pressure on the liver which can cause scarring, which makes it harder for the liver to function properly.

At Baptist Health, you will appreciate timely appointments and respectful attention to your concerns, all in a positive and friendly atmosphere. Here, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost excellent care to those who trust us with their health.

Baptist Health is known for advanced, superior care for patients with heart disease and the diagnosis, management and treatment of right-sided heart failure. The American Heart Association awarded us with the Get With the Guidelines® Bronze Award in 2016 for the consistent application of quality measures in treating heart failure.