Right ventricular failure occurs when the right side of the heart struggles to pump blood effectively to the lungs. The heart’s lower right chamber, the right ventricle, becomes weakened and cannot adequately perform its function. This difficulty in pumping blood can lead to a backup of blood in the body’s circulation. It is a form of heart failure that can affect one or both sides of the heart.
The Right Ventricle’s Function
The heart’s right ventricle plays a distinct role in the circulatory system. It receives deoxygenated blood from the body, which has already delivered oxygen to tissues and collected carbon dioxide. This blood flows into the right atrium, then passes through the tricuspid valve into the right ventricle.
From the right ventricle, this deoxygenated blood is pumped through the pulmonary valve into the pulmonary artery. The pulmonary artery carries the blood directly to the lungs, where it releases carbon dioxide and picks up fresh oxygen.
Understanding the Causes
Right ventricular failure stems from various issues that strain the right side of the heart. The most frequent cause is left-sided heart failure. When the left ventricle, which pumps oxygenated blood to the body, weakens, blood can back up into the lungs. This increased pressure then forces the right ventricle to work harder, eventually leading to its failure.
Pulmonary hypertension, or high blood pressure in the lung arteries, also commonly leads to right ventricular failure. The elevated pressure makes it more difficult for the right ventricle to pump blood forward. Over time, this increased workload can cause the right ventricle to enlarge and thicken, impairing its pumping ability.
Certain heart valve conditions also contribute to right ventricular failure. Issues with the tricuspid valve (between the right atrium and ventricle) or the pulmonary valve (between the right ventricle and pulmonary artery) can affect blood flow. For example, if the tricuspid valve doesn’t close properly, blood can leak backward, overloading the right ventricle and making it less efficient.
Other causes include direct damage to the right ventricular muscle, such as a heart attack affecting the right side (right ventricular infarction), or various cardiomyopathies. Conditions like pulmonary embolism, a sudden blockage in the lung arteries, can also acutely strain the right ventricle, leading to rapid failure.
Identifying the Symptoms
Symptoms of right ventricular failure often become noticeable due to the body’s inability to efficiently move blood forward, leading to fluid buildup. Swelling, medically termed edema, is common, particularly in the lower extremities. This fluid accumulation can also extend to the abdomen, causing a feeling of fullness or discomfort.
Another frequent symptom is shortness of breath, which may initially occur during physical activity and gradually worsen to affect individuals even at rest. This happens because the right ventricle struggles to pump blood to the lungs, indirectly affecting oxygen exchange. Patients may also experience fatigue and dizziness as the heart becomes less effective at circulating blood.
Individuals might notice weight gain over a short period due to fluid retention. Some people also report chest discomfort or pain, or a fast or pounding heartbeat. These symptoms arise from the heart’s diminished pumping capacity and resulting congestion in the systemic veins.
How Right Ventricular Failure is Diagnosed
Diagnosing right ventricular failure involves a combination of clinical evaluation and specialized tests. Healthcare providers first conduct a thorough clinical assessment, including a detailed medical history and physical examination to look for signs like swelling and jugular venous distention.
Blood tests are used, with levels of B-type natriuretic peptide (BNP) being a significant indicator. BNP is a hormone released when heart chambers are under stress or stretched, and elevated levels, often above 100 pg/mL, can suggest heart failure, including right ventricular dysfunction.
An electrocardiogram (ECG) records the heart’s electrical activity. In right ventricular failure, an ECG might show signs of right ventricular hypertrophy, such as right axis deviation, or specific patterns.
Imaging techniques provide detailed views of the heart’s structure and function. Echocardiography, which uses sound waves to create images of the heart, is a primary tool for assessing the right ventricle’s size, shape, and pumping ability. It can reveal signs like right ventricular dilation or a “D-shaped” left ventricle, indicating pressure or volume overload.
Cardiac magnetic resonance imaging (MRI) is a precise method for measuring right ventricular volumes and function. This imaging technique is useful for characterizing heart tissue and identifying various heart conditions like arrhythmogenic right ventricular cardiomyopathy or myocarditis.
Treatment Strategies
Treatment for right ventricular failure focuses on addressing the underlying cause, managing symptoms, and improving the heart’s pumping function. Optimizing fluid status is a primary goal, often achieved with diuretics like furosemide, which reduce fluid overload and systemic congestion. Diuretics decrease right ventricular preload, reducing wall tension and improving contractility.
Strategies also involve reducing the afterload on the right ventricle, the resistance it encounters when pumping blood to the lungs. In cases of pulmonary hypertension, specific therapies like PDE5 inhibitors or endothelin antagonists may be used to relax and widen the pulmonary arteries, lowering pressure. Inhaled vasodilators can also reduce pulmonary vascular resistance.
Inotropic agents can be administered to improve the contractility of the right ventricular muscle, enhancing its pumping strength. These medications can help increase cardiac output and improve blood flow to vital organs. Vasopressors are used to maintain systemic blood pressure and ensure adequate perfusion to the heart and other organs, especially in cases of low blood pressure.
When medical therapies are not sufficient, advanced interventions, including mechanical circulatory support, may be considered. Devices such as ECMO or RVADs can provide temporary support to the failing right ventricle, allowing it to recover or serving as a bridge to other treatments like heart transplantation. The choice of treatment is individualized, depending on the cause and severity of the right ventricular failure.