From the Guidelines
Right heart failure presents with several characteristic signs, including peripheral edema, jugular venous distention, ascites, hepatomegaly, fatigue, exercise intolerance, and shortness of breath, as noted in the 2018 scientific statement from the American Heart Association 1. These signs occur due to the right ventricle's inability to effectively pump blood to the lungs, causing blood to back up in the venous system and leading to increased hydrostatic pressure in the systemic circulation. Key signs of right heart failure include:
- Peripheral edema, particularly in the lower extremities
- Jugular venous distention, often visible in the neck due to elevated right atrial pressure
- Ascites, or fluid accumulation in the abdomen
- Hepatomegaly, or an enlarged liver, due to congestion of the hepatic veins
- Fatigue, exercise intolerance, and shortness of breath, especially during physical activity In advanced cases, patients may experience right upper quadrant pain from liver congestion, anorexia, and cachexia, as well as cyanosis in severe cases or when right heart failure is associated with congenital heart defects, as discussed in the European Society of Cardiology guidelines 1. Early recognition of these signs is crucial for timely intervention to prevent disease progression and complications, and diuretic therapy may be beneficial in managing fluid retention and alleviating symptoms, as noted in the European Heart Journal 1.
From the Research
Signs of Right Heart Failure
- Jugular venous distension (JVD) is a significant indicator of right heart failure, with the extent of JVD being a reliable tool for identifying heart failure exacerbation 2
- Lower extremity edema is another important sign of right heart failure, with a grade of at least 2+ being a significant predictor of heart failure exacerbation 2
- Positive hepatojugular reflux (HJR) is also a notable sign of right heart failure, although its presence is not as strongly correlated with heart failure exacerbation as JVD and lower extremity edema 2
- Inferior vena cava diameter during inspiration and expiration can also be an indicator of right heart failure, with significant differences in diameter observed across different tertiles of patients with heart failure 2
Clinical Epidemiology
- Right heart failure is a complex and diverse syndrome with unique causes and pathophysiology 3
- The right heart is recognized as a structurally discrete and functionally independent predictor of mortality, with renewed interest in its study leading to efforts to standardize definitions and unify epidemiologic studies 3
- Improvements in imaging have contributed to epidemiologic studies and understanding of right heart physiology, leading to improved diagnostics and management of right heart failure 3