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Right-Sided Heart Failure

Right heart failure usually is the consequence of left-sided

heart failure, since any pressure increase in the pulmonary

circulation inevitably produces an increased burden on the

right side of the heart. Isolated right-sided heart failure also

can occur in a few diseases. The most common of these is

severe pulmonary hypertension, resulting in right-sided

heart pathology termed cor pulmonale. In cor pulmonale,

myocardial hypertrophy and dilation generally are confied to the right ventricle and atrium, although bulging of

the ventricular septum to the left can cause left ventricular

dysfunction. Isolated right-sided failure also can occur in

patients with primary pulmonic or tricuspid valve disease,

or congenital heart disease, such as with left-to-right shunts

causing chronic volume and pressure overloads.

The major morphologic and clinical effects of pure rightsided heart failure differ from those of left-sided heart

failure in that engorgement of the systemic and portal

venous systems typically is pronounced and pulmonary

congestion is minimal.

Clinical Features

Unlike left-sided heart failure, pure right-sided heart

failure typically is associated with very few respiratory

symptoms. Instead, the clinical manifestations are related

to systemic and portal venous congestion, including hepatic

and splenic enlargement, peripheral edema, pleural effusion, and ascites. Venous congestion and hypoxia of the

kidneys and brain due to right heart failure can produce

defiits comparable to those caused by the hypoperfusion

caused by left heart failure.

Of note, in most cases of chronic cardiac decompensation, patients present with biventricular CHF, encompassing

the clinical syndromes of both right-sided and left-sided heart

failure. As congestive heart failure progresses, patients may

become frankly cyanotic and acidotic, as a consequence of

decreased tissue perfusion resulting from both diminished

forward flw and increasing retrograde congestion.

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