Right Heart Failure: Causes, Symptoms & Treatment

The heart has to go through a lot and is in action around the clock. But unfortunately, functional weaknesses of the heart are among the most common diseases in Germany, with men having a slightly higher risk than women. The likelihood of developing the disease increases with age. A special case of cardiac insufficiency is right heart failure.

What is right heart failure?

Right heart failure is a subtype of heart failure. Heart failure refers to a malfunction or weakness of the heart. The heart is no longer able to perform its tasks correctly. It can no longer pump enough blood into the body to supply all organs with sufficient blood. The circulatory system is also affected and weakened. Right heart failure affects only the right side of the heart, or the pumping capacity of the right ventricle. The right side of the heart has the task of transporting oxygen-depleted blood to the lungs, where it can be enriched with new oxygen. However, if right heart failure is present, blood backs up into the body’s veins. This increases venous pressure, causing more water to accumulate in the tissues.

Cause

The most common cause of right heart failure is chronic left heart failure. This is because it causes blood to back up into the pulmonary vessels. The result is increased pressure in the lungs. To compensate, the right side of the heart has to use more force to pump the blood into the lungs. As a result of the overload, the muscle layer in the right ventricular wall becomes thicker and thicker. As the disease progresses, the right side of the heart also fails because the overload becomes too great. Other causes of right heart failure are diseases of the lungs such as pulmonary hypertension, i.e. an abnormal increase in blood pressure in the pulmonary circulation. A valvular defect of the heart, which may be manifested, for example, by a reduction in blood flow from the right ventricle of the heart, is also a possible cause.

Symptoms, complaints, and signs

In right heart failure, a backlog of blood occurs in front of the right heart. This backlog causes edema to form in the body, mainly in the lower legs and ankles. Initially, these edemas are most noticeable at night when the heart is unloaded. In chronic right heart failure, nighttime urination (nocturia) may also occur. In some cases, there is an accumulation of fluid in the abdominal cavity (ascites), which can lead to breathing difficulties. Symptomatic of right heart failure may also be jugular venous congestion, recognizable by volume overfilling of the jugular veins. The congestion of the blood can lead to the disturbance of individual organ and body functions. The liver, kidneys, spleen or gastrointestinal tract are affected, recognizable by constipation, loss of appetite, food intolerances. In most cases, right heart failure is preceded by chronic respiratory disease or pulmonary embolism, i.e., occlusion of one or more pulmonary arteries, which also causes symptoms such as difficulty breathing, shortness of breath, and blue discoloration of the skin. Also symptomatic of chronic right heart failure are: Fatigue and decreased performance. In acute right heart failure, there is circulatory shock, shortness of breath, shortness of breath (dyspnea), increased pulse (tachicardia), and cyanosis, a blue discoloration of the skin.

Diagnosis and course

Echocardiography and a chest x-ray are usually performed to diagnose right heart failure. Echocardiography uses ultrasound to image the heart. By analyzing both the X-ray and ultrasound images, a cardiologist can quickly identify right heart failure based on the enlargement of the right side of the heart. The course of the disease in right heart failure is gradual, as the heart manages to compensate for malfunctions for a relatively long time and symptoms therefore only become noticeable relatively late. The first noticeable symptoms are a decrease in physical performance, for example during sports, as well as frequent fatigue and listlessness. In the further course, increased shortness of breath may occur. The development of edema can also cause the legs and feet to swell. In the worst case, the heart can refuse to work altogether and a heart attack can occur.

Complications

Right heart failure can have several serious consequences. If it progresses to acute decompensated heart failure, the consequences may even be life-threatening. The typical symptoms of right heart failure include edema (water retention), which primarily appears on the lower legs and the back of the foot. They are usually accompanied by an increase in weight. During the night hours, the water accumulations are removed from the body. For this reason, the patient has to interrupt his night’s rest several times to go to the toilet, which in turn causes sleep disturbances. If accumulation of blood also occurs in organs such as spleen and liver, they increase in size. Sometimes painful pressure develops on the abdomen and tissue water forms at this site, which doctors call ascites (abdominal dropsy). Right heart failure can also trigger various secondary diseases that make the heart condition even worse. Among other things, this affects the respiratory system, where pulmonary edema forms or congestive bronchitis occurs, which is manifested by a permanent cough. Another possible effect of heart failure is the significant loss of weight that occurs in a chronic form. In this case, those affected often suffer from underweight. The most serious complication of right heart failure is sudden cardiac death. The risk increases with the severity of the heart failure. Other sequelae include cardiac arrhythmias, thyroid disease, anemia, sleep apnea, or pneumonia.

When should you see a doctor?

In any case, right heart failure must be examined and treated by a doctor. In the worst case, it can lead to the death of the affected person or greatly reduce the patient’s life expectancy. The further course depends on when right heart failure is detected and treated. The earlier the diagnosis and treatment are initiated, the higher the probability of a positive course of the disease. The physician should be consulted if the affected person suffers from frequent nocturnal urination. Restrictions and discomfort in breathing may also indicate right heart failure and should always be examined by a physician. Patients often suffer from severe fatigue or various digestive complaints. If these complaints are prolonged and do not disappear on their own, a medical examination is definitely necessary. Right heart failure can be diagnosed by a cardiologist. In some cases, however, surgical intervention is necessary for treatment. Possibly, the right heart failure also limits the life expectancy of the affected person.

Treatment and therapy

The therapy of right heart failure depends primarily on the severity of the disease. At the first signs of right heart failure, it may already be sufficient to adapt the living conditions to the disease. Smoking and drinking should be reduced or stopped altogether, a normal body weight should be aimed for, and stress should be avoided. More advanced stages of heart failure can be treated with medication. These are intended to prevent possible complications and combat the symptoms of the disease. Diuretics, for example, have a diuretic effect and thus relieve the heart and the vessels in which water has accumulated. Furthermore, beta blockers]], which prevent cardiac arrhythmias, and ACE inhibitors, which dilate the blood vessels and thus relieve the heart, are frequently used. More serious cases, on the other hand, require implantation of a pacemaker or implantable defibrillator. These can respond to or prevent severe cardiac arrhythmias. If, despite all these methods, the heart failure continues to worsen, in some cases only a heart transplant can help. In this case, either a donor heart or an artificial heart is implanted in the patient. However, since such a transplant carries enormously high risks, such as a rejection reaction on the part of the body, it is only considered in an absolute emergency.

Prevention

The best way to prevent right heart failure is to lead a healthy and conscious lifestyle. Abstaining from nicotine and moderate consumption of alcohol promote heart health, as does a balanced, low-salt diet.Plenty of exercise in the fresh air, sports and avoiding too much stress in everyday life and at work can also prevent right heart failure. Even though cardiac insufficiencies are very treatable nowadays due to improved medical options and the quality of life of those affected has risen considerably, they are still among the most common types of death and should therefore not be underestimated. Because they develop insidiously, older people in particular should have regular check-ups with a cardiologist.

Follow-up

In right heart failure, symptomatic follow-up takes place to reduce the risk as much as possible. Drug treatment of the cause is appropriate. If this is hypertension, antihypertensive medications are prescribed. Furthermore, drugs are used to strengthen the pumping action of the heart and diuretics are used to reduce cardiac workload. In advanced right heart failure, the insertion of a pacemaker with an integrated defibrillator or a biventricular pacemaker is necessary. These help to compensate for the heart failure and prevent cardiac arrhythmias. If the heart is severely damaged, a heart transplant or bypass may be necessary. After the disease, a healthy lifestyle should be led. Light physical activities as well as a healthy diet are important here. Other approaches should include giving up nicotine and alcohol and avoiding obesity. Excessive fluid intake should be avoided and the correct amount should be discussed with the doctor. Check-ups at regular intervals with a specialist are important. These focus on checking the heart failure and adjusting medication if necessary. Vaccinations against influenza and pneumococcus should also be given as a precaution. The prognosis for right heart failure depends on the stage of failure. It is important to adhere to the prescribed therapy to avoid complications or worsening. Heart failure leads to death in many cases.

Here’s what you can do yourself

Therapy for right heart failure depends on the severity of the condition. Especially in mild cases, the mostly elderly patients can do a lot to prevent a chronic course with the dreaded complications such as cardiac arrhythmias, pneumonia, sleep apnea or cardiac death. Anything that puts unnecessary strain on the heart is taboo: this includes nicotine and alcohol, but also obesity. If you are already overweight, it is therefore advisable to lose weight. It makes sense here to change the diet slowly, because even a rigorous diet puts a strain on the heart. In addition, studies have shown that dietary changes, in contrast to crash diets, show long-term success. Since patients with right heart failure tend to retain water, the diet should be as low in salt as possible. Even if patients are no longer as physically fit, they can still get regular exercise in the fresh air. Walking, hiking or even cycling are sensible sporting activities. Affected patients should avoid stress, as it also damages the heart. There are various methods to reduce stress and come to a more optimistic world view. This can be done through psychotherapy, but also through gentle sports such as Reiki and yoga, meditation and breathing exercises, or Jacobson’s progressive muscle relaxation. Regular rest and sleep times additionally promote relaxation.