When Should I See A Healthcare Provider About Right Heart Failure
If you have chest pains or suspect you may be having a heart attack, call 911 or go to the nearest emergency room.
Get in touch with your healthcare provider if you experience:
- Shortness of breath.
What else should I ask my provider?
If you have right-sided heart failure, ask your provider:
- What treatment is best for me?
- Is there a special diet I should follow?
- Should I go to cardiac rehab?
- Will I need surgery?
- Will I need a heart transplant?
- What can I do to stop heart failure from progressing?
- What medications will I need?
A note from Cleveland Clinic
Right-sided heart failure means the right side of the heart can no longer pump blood efficiently. Fluid builds up in tissues, causing swelling. Treatment focuses on managing symptoms so the disease doesnt worsen. Healthy lifestyle habits, along with cardiac rehab, improve symptoms for many people. Other treatment options include cardiac devices and surgery. If you have shortness of breath, swelling or chest discomfort, talk to your healthcare provider.
What Causes Heart Failure
There are lots of reasons why you may have heart failure. It can be sudden or it can happen slowly over months or years.
The most common causes of heart failure are:
- a heart attack which can cause long-term damage to your heart, affecting how well the heart can pump.
- high blood pressureâ putting strain on the heart, which over time can lead to heart failure.
- cardiomyopathyâ a disease of the heart muscle. There are different types which can either be inherited or caused by other things, such as viral infections or pregnancy.
Heart failure can also be caused by:
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What Is The Difference Between Left And Right Sided Heart Failure
So when you have left-side heart failure, your heart can’t pump enough blood to your body. The right ventricle, or right chamber, moves used blood from your heart back to your lungs to be resupplied with oxygen. So when you have right-side heart failure, the right chamber has lost its ability to pump.
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Factors That Can Worsen Symptoms Of Heart Failure
The symptoms of heart failure can be worsened by a number of factors, including:
- too much salt, fluid, or alcohol in the diet
- some viral and bacterial infections
- kidney diseases
Treatment for heart failure may include:
- medicines, such as
- diuretics to remove excess fluid and improve symptoms of heart failure
- mineralcortiocoid receptor antagonists are also recommended and used in most patients with heart failure to reduce mortality and hospitalisation
- ACE inhibitors to open up blood vessels, reduce blood pressure and reduce sodium retention and water retention
- certain beta-blockers to slow the heart rate and reduce its work
- aldosterone blockers to reduce blood pressure and reduce the effects of damage to the heart muscle
- ACE inhibitors, beta blockers and aldosterone blockers can increase survival and reduce the likelihood of hospitalisation.
Can I Improve My Heart Failure Naturally
If your doctor prescribes you medication its important to take it. But making changes to your lifestyle is also going to have a big impact on improving your health.
Changes may include:
- weighing yourself regularly sudden weight gain may mean too much fluid is building up in your body
- watching the amount of fluid you have each day
- limiting how much alcohol you drink
- keeping active this can help improve your energy, stamina and fitness
- keeping to a healthy weight, which will help to prevent your heart from working too hard.
Diet changes are also essential when managing your weight and keeping your heart healthy.
You could feel healthier by eating:
- one or two portions of fruit or veg with every meal
- sunflower oil, olive oil, nuts and avocados instead of saturated fat options like crisps and butter
- one or two portions of beans or pulses everyday with a meal
- your protein in the form of fish, eggs and lean meats
- less salt and sugar.
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When To See A Doctor
Its a good idea to speak with your doctor to check your heart health if you:
- Notice swelling in your legs
- Become winded easily with normal activities
There is no cure for heart failure. Still, with treatment, you can slow the progression of it and stay feeling better for longer.
You should seek immediate medical attention or call 911 if you or a loved one is experiencing:
- Sudden shortness of breath, irregular heartbeat, or chest pain
- Trouble breathing and blood-tinged phlegm
- Fainting or loss of consciousness
How Can You Treat Right
Unlike left-sided heart failure, the treatments for right-sided heart failure are less straightforward.
The treatment is directed at the underlying causes of right ventricular dysfunction. If you have right-sided heart failure, your doctor will instruct you to manage your symptoms by taking diuretics, eating a low-salt diet, and limiting fluid intake. These treatments are advised for all people with right-sided heart failure.
Other suggested treatments are based on the most likely cause of right-sided heart failure.
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What Can I Do To Manage Swelling From Extra Fluid
- Elevate your legs above the level of your heart. This will help with fluid that builds up in your legs or ankles. Elevate your legs as often as possible during the day. Prop your legs on pillows or blankets to keep them elevated comfortably. Try not to stand for long periods of time during the day. Move around to keep your blood circulating.
- Limit sodium . Ask how much sodium you can have each day. Your healthcare provider may give you a limit, such as 2,300 milligrams a day. Your provider or a dietitian can teach you how to read food labels for the number of mg in a food. He or she can also help you find ways to have less salt. For example, if you add salt to food as you cook, do not add more at the table.
- Drink liquids as directed. You may need to limit the amount of liquid you drink within 24 hours. Your healthcare provider will tell you how much liquid to have and which liquids are best for you. He or she may tell you to limit liquid to 1.5 to 2 liters in a day. He or she will also tell you how often to drink liquid throughout the day.
- Weigh yourself every morning. Use the same scale, in the same spot. Do this after you use the bathroom, but before you eat or drink. Wear the same type of clothing each time. Write down your weight and call your healthcare provider if you have a sudden weight gain. Swelling and weight gain are signs of fluid buildup.
Pathophysiology Of Heart Failure
Heart failure typically begins with the left side of the heart, in particular the left ventricle the hearts main pumping chamber. The right side of the heart can also be involved, or both sides.
How well the heart is pumping can be measured by how much blood is pumped out with each beat . A healthy heart will have an ejection fraction of 50 per cent or higher it pumps out at least half the volume of blood that fills its chambers with each beat. The ejection fraction result is used to help determine the severity of heart failure and to guide treatment.
In heart failure, the left ventricle may not fill between beats or may have become stiff and unable to squeeze effectively. The heart muscle may become damaged and weak, and eventually, the ventricles may stretch so much that the heart cannot pump enough blood through the body.
The heart muscle may become damaged and weak, and unable to pump enough blood around the body.
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About Heart And Vascular Institute
The UPMC Heart and Vascular Institute has long been a leader in cardiovascular care, with a rich history in clinical research and innovation. As one of the first heart transplant centers in the country and as the developer of one of the first heart-assist devices, UPMC has contributed to advancing the field of cardiovascular medicine. We strive to provide the most advanced, cutting-edge care for our patients, treating both common and complex conditions. We also offer services that seek to improve the health of our communities, including heart screenings, free clinics, and heart health education. Find an expert near you.
Shortness Of Breath While Lying Flat And With Exertion
Shortness of breath while lying flat. People who have left heart failure may experience shortness of breath when lying flat . The person will start using two or three pillows to prop themselves up while in bed so that they can breathe easier. If the shortness of breath is more severe, the person may begin sleeping in a chair or recliner.
Shortness of breath with exertion. Shortness of breath with exertion is referred to as dyspnea on exertion. Dyspnea on exertion occurs because the lungs cannot supply enough oxygen and the heart cannot adequately pump oxygen-rich blood to the body. Initially, the shortness of breath may occur when walking long distances or up flights of stairs, but as the heart failure progresses, less activity may produce more symptoms.
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Know The Right Resuscitation For Right
The exploration started in 2004 with a 62-year-old man who presented to an emergency department with acute shortness of breath, tachycardia with chest discomfort, and light-headedness, Amado Alejandro Baez, MD, said in a presentation at the American College of Emergency Physicians 2022 Scientific Assembly.
The patient arrived on day 20 after a radical cystoprostatectomy. He had driven 4 hours from another city for a urology follow-up visit. On arrival, he developed respiratory distress symptoms and presented to the emergency department, said Baez, professor of emergency medicine and epidemiology at the Medical College of Georgia/Augusta University and triple-board certified in EMS, emergency medicine, and critical care.
The patient developed a massive pulmonary embolism with acute cor pulmonale . An electrocardiogram showed an S1Q3T3, demonstrating the distinctive nature of right ventricular failure, said Baez.
Electrocardiogram at presentation to the emergency department.
Research has demonstrated the differences in physiology between the right and left ventricles, he said.
Baez highlighted some of the features of right ventricle failure and how to manage it. Notably, the RV is thinner and less resilient. “RV failure patients may fall off the Starling curve,” in contrast to patients with isolated left ventricle failure, he said.
Avoiding systemic hypotension can prevent sequelae, such as myocardial ischemia and further hypotension, he said.
Systolic Heart Failure Prognosis
Prognosis for systolic heart failure, and left-sided heart failure in general, varies depending on the cause of the condition, severity of symptoms and presence of co-existing medical problems. Some may improve with medication and lifestyle changes. For others, severe symptoms can be life-threatening and require an implanted device, surgical heart repair or a heart transplant.
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What Are The Symptoms
Your feet, legs, and ankles will likely to swell because blood is backing up in your veins. This symptom is called edema.
- If it backs up into your stomach or liver, you may notice that your abdomen is distended, too.
- You might find that you have to go to the bathroom more, especially at night. This is caused by fluid buildup, too.
As your heart failure gets worse, you may also see some of these symptoms:
- Itâs hard to breathe.
- Your neck veins are swollen.
- Your pulse is fast or feels âoff.â
- Your chest hurts.
- Youâre gaining weight from excess fluid.
- You donât feel like eating.
- Your skin is cold and sweaty.
- Youâre very tired.
Precipitating Causes Of Heart Failure
A previously stable, compensated patient may develop heart failure that is clinically apparent for the first time when the intrinsic process has advanced to a critical point, such as with further narrowing of a stenotic aortic valve or mitral valve. Alternatively, decompensation may occur as a result of the failure or exhaustion of the compensatory mechanisms but without any change in the load on the heart in patients with persistent, severe pressure or volume overload. In particular, consider whether the patient has underlying coronary artery disease or valvular heart disease.
The most common cause of decompensation in a previously compensated patient with heart failure is inappropriate reduction in the intensity of treatment, such as dietary sodium restriction, physical activity reduction, or drug regimen reduction. Uncontrolled hypertension is the second most common cause of decompensation, followed closely by cardiac arrhythmias . Arrhythmias, particularly ventricular arrhythmias, can be life threatening. Also, patients with one form of underlying heart disease that may be well compensated can develop heart failure when a second form of heart disease ensues. For example, a patient with chronic hypertension and asymptomatic LV hypertrophy may be asymptomatic until an MI develops and precipitates heart failure.
- Profound anemia
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Heart Failure With Preserved Ejection Fraction
In diastolic heart failure , the same pathophysiologic processes occur that lead to decreased cardiac output in systolic heart failure, but they do so in response to a different set of hemodynamic and circulatory environmental factors that depress cardiac output.
In HFpEF, altered relaxation and increased stiffness of the ventricle occur in response to an increase in ventricular afterload . The impaired relaxation of the ventricle then leads to impaired diastolic filling of the left ventricle .
Morris et al found that right venticular subendocardial systolic dysfunction and diastolic dysfunction, as detected by echocardiographic strain rate imaging, are common in patients with HFpEF. This dysfunction is potentially associated with the same fibrotic processes that affect the subendocardial layer of the LV and, to a lesser extent, with RV pressure overload. It may play a role in the symptomatology of patients with HFpEF.
What Are Compression Socks
- Compression stockings are specially made, snug-fitting, stretchy socks that gently squeeze your leg.
- Graduated compression or pressure stockings are tighter around your ankle and get looser as they move up your leg.
- Compression sleeves are just the tube part, without the foot.
- Pressure from compression socks helps the blood vessels work better in the legs. This allows the arteries that take oxygen-rich blood to the muscles can relax, so blood flows freely. The veins get a boost pushing blood back to the heart.
- Compression stockings are a worm for comfort, to help prevent serious medical conditions, and compete better in sports.
- Compression stockings can:
- Lower the chances of getting a blood clot in the leg
- Lessen pain and leg swelling
People should who wear compression socks include:
- People with or at risk for circulation problems, like blood clots in the leg , varicose veins, or diabetes
- People who have just had surgery
- People who cant leave their bed or have a hard time moving their legs
- People who stand all day at work
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Treatment Of Heart Failure Congestive In Dogs
Dogs with moderate to severe problems may need to be hospitalized until the condition is stabilized. Taps will be inserted to remove fluid from the abdomen and around the heart . Strong diuretics, such as furosemide, may be injected to further encourage fluid elimination, and dogs may need additional oxygen.
Once the immediate attack is stabilized, long-term medications will be prescribed to help to control symptoms. Diuretics and ace inhibitors are the most common medications used to reduce fluid build-up and improve blood flow. Pimobendan can increase the force of the hearts contractions, and digoxin may be prescribed if your dogs heart rate is very fast. Beta-blockers and calcium blockers could also be suggested depending on your dogs condition. Most treatment plans will combine a number of different medications.
Other treatment will focus on eliminating the problem that is causing CHF. If your dog has heartworm, it can be treated with medication once your dogs symptoms are stabilized. Some conditions, like atrial septal defect, can be treated with surgery. Others cannot. Valve replacement is only done very rarely in dogs, so problems that affect the valves are often only untreatable symptomatically.
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Early Symptoms Of Heart Failure
A person with early heart failure might not have any noticeable signs. When early symptoms occur, they can be subtle and easy to miss or ignore. Early signs of heart failure include:
- Shortness of breath, at first when youre active and later even when youre sitting or lying down
- Lowered ability to exercise or be active
- Confusion or forgetfulness
- Frequent fatigue, sleepiness or weakness
- Palpitations, or a fluttering feeling in your chest, as the heart pumps harder and faster
Without treatment, heart failure can worsen over time. Symptoms that were once mild can become increasingly more severe, and may prevent you from doing everyday tasks.
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