From the Guidelines
Right-sided heart failure primarily causes symptoms related to fluid backup in the systemic venous circulation, including peripheral edema, ascites, hepatomegaly, jugular vein distention, and fatigue, as noted in a scientific statement from the American Heart Association 1.
Common Symptoms
The most common symptoms of right-sided heart failure include:
- Peripheral edema (swelling in the ankles, feet, and legs)
- Ascites (fluid accumulation in the abdomen)
- Hepatomegaly (enlarged liver)
- Jugular vein distention (visible neck vein swelling)
- Fatigue Patients may also experience weight gain due to fluid retention, decreased exercise tolerance, and nocturia (frequent nighttime urination) 1.
Advanced Symptoms
In advanced cases, patients might develop hepatic congestion leading to right upper quadrant discomfort, anorexia, and nausea, as a result of the failing right ventricle's inability to effectively pump blood forward, causing blood to back up in the venous system 1.
Pathophysiology
This increased venous pressure forces fluid out of blood vessels into surrounding tissues, particularly in dependent areas like the legs and abdomen, leading to the aforementioned symptoms.
Management
Treatment typically focuses on reducing fluid overload with diuretics, addressing the underlying cause, and sometimes using medications that improve heart function, such as ACE inhibitors or beta-blockers, although specific therapies promoting stabilization and recovery of RV function are lacking 1.
From the Research
Right Sided Failure Symptoms
The symptoms of right sided failure can be identified through various studies, including:
- Jugular venous distension (JVD) and lower extremity edema are significant indicators of right sided failure, as shown in a study published in 2018 2
- The presence and extent of JVD and lower extremity edema, and a positive hepatojugular reflux (HJR) are better than other signs and symptoms in identifying severity of heart failure exacerbation among patients with an ejection fraction (EF) ≤ 30% 2
- Common symptoms of right-sided heart failure include hypotension, jugular venous distention, and peripheral edema, as noted in a study published in 2025 3
Key Clinical Manifestations
Key clinical manifestations of right ventricular myocardial infarction, which can lead to right sided failure, include:
- Hypotension
- Jugular venous distention
- Peripheral edema, as mentioned in a study published in 2025 3
- These symptoms are also related to the pathophysiology of right ventricular myocardial infarction, which involves impaired right ventricular function, decreased cardiac output, and poor hemodynamic stability 3
Comparison with Other Studies
Other studies, such as one published in 2021, highlight the importance of considering right-sided heart failure when evaluating patients for left-sided heart failure, and note that common causes of acute right-sided heart failure include pulmonary embolism and hypoxemia 4