From the Guidelines
Right-sided heart failure is primarily caused by conditions that increase pressure in the pulmonary circulation or directly damage the right heart, with the most common causes being left-sided heart failure, pulmonary hypertension, and right ventricular infarction. The causes of right-sided heart failure (RHF) can be categorized into three main mechanisms: decreased right ventricular (RV) contractility, RV volume overload, and RV pressure overload 1. According to a scientific statement from the American Heart Association, the causes of RHF include primary cardiomyopathies with RV involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease 1.
Some of the specific causes of RHF include:
- Decreased RV contractility: acute causes such as RV myocardial infarction, myocarditis, and perioperative injury/ischemia, as well as chronic causes like arrhythmogenic right ventricular cardiomyopathy and Ebstein anomaly 1
- RV volume overload: conditions such as tricuspid regurgitation, pulmonary regurgitation, and left-sided valvular heart disease 1
- RV pressure overload: causes including pulmonary arterial hypertension, chronic thromboembolic pulmonary hypertension, and pulmonic stenosis 1
It is essential to identify and address the underlying cause of RHF to improve morbidity, mortality, and quality of life. Treatment strategies may involve managing symptoms with diuretics, ACE inhibitors, and specialized pulmonary vasodilators, depending on the specific etiology 1.
From the Research
Causes of Right Sided Heart Failure
- Right-sided heart failure (RHF) occurs from impaired contractility of the right ventricle caused by pressure, volume overload, or intrinsic myocardial contractile dysfunction 2
- The right heart is being recognized as a structurally discrete and functionally independent predictor of mortality, with unique causes and pathophysiology 3
- Pulmonary hypertension is a major cause of right heart failure, involving both adaptive and maladaptive patterns of right ventricular change 4
Pathophysiology
- The development of subclinical right ventricle (RV) dysfunction or overt RHF is a negative prognostic indicator 2
- RV-specific inflammatory growth factors and mediators of myocardial fibrosis play a role in the mechanisms leading to RHF 2
- Adaptation of right ventricular (RV) function to increased afterload, known as RV-arterial coupling, is a key determinant of prognosis in pulmonary hypertension 5
Clinical Epidemiology
- Right heart failure is a complex and diverse syndrome with various causes and epidemiology 3
- Improvements in imaging have contributed to epidemiologic studies, as well as understanding of right heart physiology, which has subsequently led to improved diagnostics and management 3
- The systemic consequences of pulmonary hypertension and right-sided heart failure affect multiple organ systems, including left heart, brain, kidneys, liver, gastrointestinal tract, skeletal muscle, as well as the endocrine, immune, and autonomic systems 6