What Is Right Heart Failure? 

Usually when we refer to heart failure, we are talking about left heart failure. However, there are some people in this community who also experience right heart failure.

What is right-sided heart failure? What causes it? What are the symptoms? To understand right heart failure, we must begin with some basic anatomy.

Basic anatomy of the heart

As you may know, there are two sides to your heart – the left heart and right heart. Your left heart receives oxygenated blood from the lungs. It then pumps this oxygenated blood through your arteries to all the tissues of the body. To pump blood through the arteries, your left heart must generate quite a bit of pressure. So, its walls are thick and powerful.^1,2

Your right heart receives unoxygenated blood from your veins. Since blood return from your veins may vary, your right heart’s walls are much more flexible than your left heart’s walls. These walls are also much thinner than the walls of the left heart.

This means the right heart is weaker than the left heart, but when you have healthy lungs, the right heart doesn’t have to work very hard to pump blood through them. The right heart only needs to generate about a quarter of the force needed by the left heart. (For more about heart anatomy, check out my post Anatomy of the Heart.)^1-5

What is heart failure?

When the generic term "heart failure" is used, we are usually referring to left heart failure, but the right heart can sometimes fail too.

Left heart failure is a term for when the left side of the heart becomes a weaker pump. Because it is a weaker pump, it is less effective at pumping oxygenated blood to all the tissues of the body. There are many causes for this.

Right heart failure is a term for when the right side of the heart becomes a weaker pump.

What causes right heart failure?

Right heart failure is usually caused by pulmonary hypertension. This is when the blood pressure in the lungs is abnormally high. There are certain conditions that may cause this to happen. Some of the most common are listed below. ⁶

Severe left heart failure

Left heart failure is the most common cause of right heart failure. Left heart failure means the left heart is less capable of pumping blood through the arteries, so some of the blood pools in the right heart, pulmonary veins, and lungs. This increases the blood pressure in the lungs. It also makes the right heart work harder to pump blood through the lungs. Over time, this may cause the right heart to become a weaker pump.^1,2,7

Heart diseases that affect the right heart

One example of this is a heart attack on the right side of the heart. This can cause damage to the heart muscle, thereby making it a weaker pump. Another example is cardiomyopathy, which affects the right heart. This is a heart disease that makes the heart a weaker pump. Another example is disease of the tricuspid valve, which separates the upper chamber (atria) and lower chamber (ventricle) of the right heart.^1,2,5,8

Congenital heart disease

These are heart diseases that infants are born with. You can read more about them in my post Let’s Discuss Congenital Heart Disease. Some types of congenital heart disease affect the right heart and may contribute to right heart failure.^1,5

Pulmonary embolism

A pulmonary embolism is a blood clot in the lungs. The heart has to work harder to pump blood past the embolism. This may wear out the right heart, thereby leading to right heart failure.^1,2,5

Lung diseases

Examples of lung diseases include severe COPD, pulmonary fibrosis, and cystic fibrosis. Low oxygen levels cause blood vessels in the lungs to constrict, increasing the blood pressure inside the lungs. This means the right heart has to work harder to pump blood through the lungs. After years of pumping blood through diseased lungs, the right heart may become a weaker pump. Right heart failure caused by lung disease is usually called "cor pulmonale."²

What are the symptoms of right heart failure?

Some of the symptoms are the same as left heart failure, including fatigue, shortness of breath, and chest tightness.¹

Keep in mind that right heart failure causes venous congestion. This is due to blood backing up in the veins, and helps explains the following classic signs of right heart failure:^1,2,5,7

• Jugular vein distention. The jugular veins run along either side of the neck. With right heart failure, they tend to bulge out.
• Foot and ankle edema. Fluid builds up in the lower regions of the body, especially the feet and ankles, causing swelling. Fluid may also accumulate in the lower legs. This may be present with left heart failure, but it is usually more prevalent with right heart failure.
• Stomach distention. Fluid may build up in the abdominal region. This can make the stomach look swollen and full.

A complex disease

As with many conditions, heart failure is a very complex disease. Have you been diagnosed with right heart failure? Please share about your experiences in the stories section by clicking the button below.