Right heart failure natural history

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jad Z Al Danaf; Rim Halaby

Right heart failure, if left undiagnosed and untreated, may lead to impaired quality of life and eventually death. There are several factors that define this natural history depending mainly on the underlying etiology or mechanism of injury, the onset of illness, how early was treatment initiated and other comorbidities.

The prognosis of right heart failure depends in large part on the underlying cause of the condition. Giving oxygen often improves symptoms, stamina, and survival. Treating primary pulmonary hypertension often leads to greater stamina and a longer life. In some cases, a lung transplant or heart-lung transplant can extend survival.

• Left ventricular failure via ventricular interdependence or same underlying cardiomyopathy
• Tachyarrhythmias (RV tachycardia, RV fibrillation, Atrial fibrillation, Atrial flutter)
• Bradyarrhythmias (sinus node dysfunction, complete heart block)
• Nutmeg or congested liver
  • As result of the right ventricular failure, blood backs up into the system venous system, including the hepatic vein. Chronic congestion in the centrilobular region of the liver leads to hypoxia and fatty changes of more peripheral hepatocytes, leading to what’s known as nutmeg liver.
• Lower extremity venous stasis leading to increased risk of deep venous thrombosis thus pulmonary embolism, which in-turn worsens right ventricular dysfunction
• In severe RHF, decreased pulmonary circulation leads to decreased CO with possible eventual syncope, collapse and sudden death.^[1]

• Of the most common factors that determine the prognosis in right ventricular dysfunction:
  • Tricuspid regurgitation (annular area and velocity)
  • Right ventricular ejection fraction and degree of dilatation, if any.
  • Right atrial size
  • Tissue Doppler of the RV highlighting the level of tissue strain and displacement.
  • Brain natriuretic peptide level
  • Arrhythmia complications^[2]

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