Disease Description (Causes and Symptoms)
Right heart failure is a condition in which congestion occurs in the systemic circulation (systemic veins) due to increased pressure in the right ventricle and right atrium, and systemic cardiac output may decrease due to changes in right ventricular preload, afterload, and ventricular interdependence.
Major causes:
- Increased right ventricular afterload: pulmonary embolism, pulmonary hypertension (primary/secondary), hypoxia
- Decreased right ventricular contractility: right ventricular myocardial infarction (right-sided myocardial infarction), myocarditis, dilated/hypertrophic cardiomyopathy
- Preload/volume overload: tricuspid regurgitation, fluid overload
- Other: cardiac tamponade, mechanical ventilation (positive-pressure ventilation), etc.
Major symptoms (including typical symptoms):
- Peripheral edema (of the feet/legs or generalized), abdominal distension, ascites
- Hepatomegaly due to hepatic congestion, right upper quadrant discomfort/pain, loss of appetite, nausea/vomiting, constipation
- Decreased urine output, decreased nocturia, azotemia (when cardiorenal function worsens)
- Increased jugular venous pressure (elevated JVP), fatigue, dyspnea (when accompanied by left heart failure or lung disease)
Treatment Methods and Precautions
The goals of treatment are to relieve venous congestion, optimize right ventricular preload and afterload, treat the underlying disease, and prevent complications.
Major treatments:
- Medication
- Diuretics (such as loop diuretics): relieve congestion by reducing fluid volume (first-line choice)
- Inotropes (such as dobutamine and milrinone): used short-term when cardiac output needs to be maintained
- Pulmonary vasodilators: when pulmonary hypertension is the cause, prostacyclin agents, endothelin receptor antagonists, PDE5 inhibitors, etc. may be considered
- Anticoagulant therapy: standard treatment when pulmonary embolism is the cause
- Procedures/Surgery
- Correction of the cause of right ventricular dysfunction (e.g., coronary intervention or coronary artery bypass grafting for RV infarction)
- Valve surgery or percutaneous repair/correction when tricuspid regurgitation is severe and symptoms persist
- Mechanical support: ECMO, a right ventricular assist device (RVAD), etc. may be considered in severe refractory right heart failure
- Other management
- Oxygen therapy (when hypoxia is present)
- Fluid and sodium restriction, weight monitoring, blood pressure and kidney function monitoring
- Arrhythmia management (electrocardiographic monitoring, and antiarrhythmic treatment or electrical procedures when necessary)
Precautions and risk of complications:
- Excessive diuresis may cause hypotension, worsening kidney function, and electrolyte abnormalities → kidney function and electrolyte monitoring are necessary
- Risk of bleeding when anticoagulants or antiplatelet agents are used
- During acute deterioration, shock, hepatic failure (cardiogenic hepatic congestion), severe kidney failure, and cardiac arrest may occur
- Drug interactions when medications are combined (e.g., caution is needed when antihypertensive agents and inotropes are used together)
Recommended self-management:
- Limit daily salt intake (follow the doctor’s instructions), measure body weight daily, and report immediately if it increases rapidly
- Avoid NSAIDs (nonsteroidal anti-inflammatory drugs) because they can worsen fluid retention
- Adhere strictly to medication schedules and have regular kidney function and electrolyte tests
- Visit a medical institution immediately if emergency signs occur, such as dyspnea, sudden worsening of edema, or decreased consciousness
Outpatient Visit Checklist (Including Preparation Items and Example Questions)
Items and records to prepare:
- List of medications currently being taken (including prescription drugs, over-the-counter medicines, and health supplements)
- Recent records of weight changes (daily records for at least 2 weeks if possible)
- Notes on when symptoms began and how they have changed (dyspnea, edema, urine output, etc.)
- Copies or summaries of previous test results (echocardiography, chest X-ray, electrocardiogram, blood tests, etc.)
- Records of blood pressure, heart rate, and oxygen saturation measurements, if available
- Past medical history (myocardial infarction, pulmonary embolism, lung disease, heart surgery, etc.) and history of surgeries/procedures
Examples of useful questions to ask during an outpatient visit (for patients to check themselves):
- Record the days/times when symptoms worsened and note changes in activity, meals, and medication use before and after that time
Examples of General Questions to Ask the Doctor
- What do you think is causing this condition? What is the main cause of my right heart failure?
- What treatment (medication/procedure) do you recommend, and what are its expected benefits and risks (side effects)?
- Are there any foods or medications I should be careful about while taking my medications (e.g., salt, NSAIDs, or supplements)?
- How much exercise is allowed in daily life, and what restrictions should I follow?
- When should I visit the emergency room (what specific symptoms and measurements should I look for)?
Examples of Disease-Specific Questions
- In my case, how can it be determined whether the right heart failure is caused by pulmonary hypertension or by right ventricular injury (myocardial infarction/cardiomyopathy)? Are additional tests (right heart catheterization, pulmonary vascular tests, etc.) necessary?
- If tricuspid regurgitation is the main cause of my right heart failure, when should surgery (or percutaneous treatment) be performed, and what is the prognosis?
(Note: The choice of treatment and tests varies according to the individual’s clinical condition, comorbidities, and test results. Consult the treating physician regarding specific prescriptions and decisions.)