Heart failure
Right heart failure
What is right heart failure?
The right side of your heart pumps used, oxygen-depleted blood from your body back into your lungs to be re-oxygenated.
If you have right heart failure, that means your right ventricle, (shown in blue in the animation), isn’t working properly; your heart is unable to draw blood from your body and push it out to your lungs efficiently.
Take a look at Your heart: The basics if you’d like to know more about how your heart works.
In a normal heart, the right ventricle should be able to squeeze 50% to 75% of its blood out into the body with each contraction. In a failing heart, that percentage, which is called the ejection fraction, will be 40% or less.
Blood will tend to pool in your body and your legs and feet will swell. You may also develop shortness of breath and feel tired.
If you have left heart failure, that will increase your risk of developing right heart failure, because your left ventricle’s failure to pump properly can put a strain on your right ventricle.
Disorders that increase the amounts of fluid and pressure in your lungs, like emphysema and chronic obstructive pulmonary disease, will also raise your risk of developing right heart failure.
When you have both left and right heart failure, you have what is called biventricular heart failure.
Right heart failure: Right ventricle and ejection fraction
What causes right heart failure?
Heart failure can have many different causes. Anything that damages the heart or interferes with its ability to function can ultimately cause heart failure.
Right heart failure, by itself (that is, not combined with left heart failure), is often caused by problems with your pulmonary (lung) circulation.
Anything that increases the amount of fluid and pressure in your lung circuit and makes it difficult for your right ventricle to pump blood into your lungs can cause right heart failure. The constant strain ultimately damages the right side of your heart.
Disorders that cause pulmonary hypertension – high blood pressure in the vessels of your lungs – can greatly increase your risk of right heart failure.
Other lung problems that can lead to right heart failure include disorders like chronic obstructive pulmonary disease (COPD), emphysema, and pulmonary emboli (blood clots in the lungs).
However, most of the time, right heart failure develops as a result of long-term, severe left heart failure. And when you develop right heart failure because of your left heart failure, you wind up with failure of both sides of your heart and that is called biventricular heart failure.
Common causes of right heart failure include:
- Left heart failure: When left heart failure leads to right heart failure, the result is biventricular heart failure
- Serious chronic lung diseases like COPD and emphysema
- Pulmonary emboli (lung blood clots)
- Anything that causes pulmonary hypertension, including diseases like lupus, some congenital disorders, and (rarely) pulmonary hormonal disorders
What are the symptoms of right heart failure?
If you have right heart failure you will probably experience symptoms caused by the effects of fluid build-up in your body, especially in your legs and feet.
You may also have difficulty breathing, and you may feel some chest discomfort and fatigue.
One occasional symptom is nocturia, or frequent urination at night. This happens because, when you lie down, the extra fluid in your legs and feet moves back toward the middle of your body and your kidneys then get busy and try to remove it.
Common symptoms of right heart failure include:
- Swelling in the feet and legs
- Difficulty breathing, even with mild exercise
- Rapid heartbeat
- Chest discomfort
- Tiredness
Swelling, or edema, of the feet and legs
How is right heart failure treated?
Your doctor will determine the best course of treatment based on the severity of your heart failure and will focus on treating its underlying cause (which may be left heart failure or problems with your pulmonary circulation).
Not all causes of right heart failure can be treated.
Treatment of any chronic pulmonary disease is very important, and home oxygen therapy may help to reduce the load on your lungs.
Diuretics may be prescribed to reduce your fluid load and help you to manage symptoms such as swollen feet and ankles.
Treatments for right heart failure include:
- Treatment of left heart failure
- Treatment of any chronic pulmonary disorders that may be contributing to your right heart failure
- In cases of lung emboli: Treatment with anticoagulants to prevent clots
- Treatment of other underlying causes, such as lupus
- Diuretics to help manage your fluid load and reduce swelling
What are the aims of treatment?
The aims of treatment for people with right heart failure are to relieve symptoms like breathlessness and swelling, to help your heart recover, and to prevent or slow further weakening of your heart muscles.