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Right-Sided Heart Failure: Symptoms, Causes, and Treatment

Medically reviewed by Angelica Balingit, M.D.
Written by Emily Wagner, M.S.
Posted on October 12, 2023

From the minute we’re born, our hearts are beating to pump necessary oxygen and nutrients to our body’s cells and tissues. A healthy heart is key to a healthy life — and when living with a lung disease like pulmonary hypertension (PH), it’s important to know how your condition affects this vital muscle.

Right-sided heart failure (cor pulmonale) develops when the right side of your heart can no longer pump blood to your lungs. Unfortunately, PH is one of the main causes of this disease. If you’re living with PH, it’s important to be aware of your risk of heart failure and what symptoms to look out for.

This article will cover everything you need to know about right-sided heart failure and your treatment options. Your doctor can work together with your cardiologist (heart specialist) and pulmonologist (lung specialist) to help you live a healthier life.

What Is Right-Sided Heart Failure?

Your heart has two sides — right and left. Within each side, there’s an upper chamber, or atrium, and a lower chamber, or ventricle. These chambers work together to move blood from your lungs out to your body and then back toward your heart.

The right ventricle pumps blood from the heart to the lungs. Right-sided heart failure occurs when the right ventricle can no longer pump blood properly. (Adobe Stock)

The right ventricle is responsible for pumping blood from your heart to your lungs. It travels through the pulmonary arteries that carry oxygen-poor blood from your body. Once the blood reaches your lungs, carbon dioxide is removed and replaced with oxygen. This oxygen-rich blood moves back toward your heart and is pumped out by the left ventricle to the rest of your body.

Right-sided heart failure — also known as right ventricular failure — occurs when your right ventricle can no longer pump blood properly. The blood begins building up in your veins, leading to symptoms like shortness of breath and edema (swelling).

What Causes Right-Sided Heart Failure?

One cause of right-sided heart failure is pulmonary hypertension, which leads to high blood pressure in your lungs’ blood vessels. Specifically, the blood vessels become blocked or narrowed, making it harder for blood to flow through. Your right ventricle has to work harder to pump blood to your lungs. Over time, this extra effort weakens the right side of your heart, leading to heart failure.

Other health conditions that reduce blood oxygen levels can also cause right-sided heart failure, including:

  • Congenital heart diseases that cause heart defects
  • Chronic obstructive pulmonary disease (COPD)
  • Cystic fibrosis
  • Obstructive sleep apnea
  • Repeated pulmonary embolisms or blood clots in the lungs
  • Interstitial lung disease (scar tissue in the lungs)
  • Left-sided heart failure from a heart attack, coronary artery disease, or high blood pressure

Symptoms of Right-Sided Heart Failure

When the right side of your heart fails, fluid builds up in other veins around your body. As a result, the first noticeable signs of right-sided heart failure are edema and shortness of breath. Your doctor may refer to this as congestive heart failure because your body becomes “congested” with fluid.

You may notice swelling in your feet and legs first because your heart and veins are trying to work against gravity. As your disease progresses, the swelling can affect other parts of your body. The extra fluid can also collect in your lungs, making it harder to breathe. This is known as pulmonary edema, and it causes respiratory distress (low blood oxygen levels).

One myPHteam member wrote about their symptoms of right-sided heart failure: “I’ve overworked and stressed my heart to the point of right-sided heart failure. I had chest pain and dizziness, most likely because of heart failure. I also had symptoms of PAH, such as shortness of breath, fast heart rate, and high blood pressure.” (“PAH” stands for “pulmonary arterial hypertension,” a type of PH caused by constriction and damage in small blood vessels in the lungs.

Other heart failure symptoms to look out for include:

  • Weakness and fatigue
  • Chest pain
  • Weight gain from edema
  • Palpitations (racing heartbeat)
  • Coughing or wheezing
  • Bloating, appetite loss, and nausea from fluid buildup in the abdomen

At first, you may notice symptoms like getting short of breath only when you’re active. Over time, you can have symptoms with even light exercise or rest. Right-sided heart failure can become debilitating if left untreated.

Some myPHteam members have shared how living with this disease has affected their lives. “I was diagnosed in 2021 after having a severe case of COVID-19. I have PAH and right-sided heart failure,” one member said. “I was forced to retire from nursing and start on disability, and I’m still having a hard time accepting it.”

How Is Right-Sided Heart Failure Diagnosed?

If you’re experiencing symptoms of right-sided heart failure, it’s important to talk with your doctor as soon as possible. The sooner you’re diagnosed and start treatment, the better your chances of avoiding complications.

Your doctor will start with a physical exam to check for swelling in your feet, legs, and abdomen. They’ll also listen to your heart and take a blood sample to check for B-type natriuretic peptides. High levels of these hormones may indicate heart failure.

Other tests used to diagnose right-sided heart failure and monitor your PH or PAH include:

  • Chest X-ray — Takes images of your heart and lungs to check for abnormalities
  • Echocardiogram — Uses sound waves to show structures in your heart and how well blood flows through
  • Electrocardiogram — Measures the electrical activity in your heart
  • Cardiac MRI — Checks right ventricle volume and function

If your doctor suspects you have heart failure, they can confirm the diagnosis using right-heart catheterization. During this test, your doctor will insert a thin tube called a catheter into the right side of your heart and guide it to the pulmonary artery. There, they’ll measure the blood pressure inside your lungs and heart. Right-heart catheterization is a useful test for several heart conditions, including right-sided heart failure and PH.

Treatment Options for Right-Sided Heart Failure

Your doctor will likely recommend a combination of lifestyle changes and medications to help lower your blood pressure. “I have right-sided heart failure. I’m on medications, eat right, and try to stay active. I lost some weight and feel a bit better,” wrote a myPHteam member.

Lifestyle Changes

People with mild right-sided heart failure should make healthy lifestyle changes as early as possible to improve their quality of life. Your doctor can provide resources to help you start a healthy diet. When living with heart failure, it’s important to limit your salt intake and eat plenty of fruits and vegetables.

You can also improve your heart health by making changes like these:

  • Start an appropriate exercise plan.
  • Limit or avoid caffeine and alcohol.
  • Quit smoking.
  • Find new ways to manage stress, like meditation or yoga.
  • Build healthy sleep habits.

Medications

Many heart failure and PH medications treat high blood pressure by relaxing your blood vessels. Others help slow your heart rate, taking extra force off your weakened heart muscle. Your doctor may prescribe drugs such as the following:

  • Angiotensin receptor blockers
  • ACE inhibitors
  • Beta-blockers
  • Angiotensin receptor plus neprilysin inhibitors

Diuretics, or water pills, help your kidneys get rid of extra fluid in your body. These medications treat swelling from right-sided heart failure.

Medications have helped some myPHteam members regain their strength. “I’ve been on triple therapy with Adcirca, Opsumit, and IV Remodulin for about 10 months, and it’s made all the difference in the world,” one member shared. “In fact, my heart failure symptoms have improved. I feel almost normal again.”

Heart and Lung Transplants

In severe cases of right-sided heart failure caused by PH, you may need a heart, lung, or heart-lung transplant. This is a last-resort treatment if lifestyle changes and medications haven’t worked. A team of health care providers will help guide you if this is determined to be the best way forward to improve your quality of life while living with PH.

Talk With Others Who Understand

On myPHteam, the social network for people with pulmonary hypertension and their loved ones, more than 51,000 members come together to ask questions, give advice, and share their stories with others who understand life with pulmonary hypertension.

Are you living with right-sided heart failure and pulmonary hypertension? What medications do you take to manage it? How has PH affected your life? Share your experience in the comments below, or start a conversation on your Activities page.

    Posted on October 12, 2023
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    Angelica Balingit, M.D. is a specialist in internal medicine, board certified since 1996. Learn more about her here.
    Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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