Heart Failure: Left vs Right

By VeriScorePrep Team · 6 min

Heart failure is impaired pumping that backs fluid up upstream. Which side fails predicts where fluid pools.

Left-sided heart failure

The left ventricle cannot eject effectively, so blood backs into the lungs. Signs: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, crackles, cough, frothy sputum, tachypnea. Reduced cardiac output causes fatigue and activity intolerance.

Right-sided heart failure

Often a consequence of left-sided failure or lung disease (cor pulmonale). The right ventricle cannot push into pulmonary circulation, so blood backs into the systemic venous system. Signs: peripheral edema, jugular venous distention, hepatomegaly, ascites, weight gain.

Management

Diuretics reduce preload, ACE inhibitors/ARBs reduce afterload, beta-blockers slow remodeling, and digoxin improves contractility (watch for toxicity, especially with hypokalemia). Daily weights at the same time, same scale, same clothing catch fluid shifts early. A 2–3 lb gain in a day or 5 lb in a week signals worsening failure.

Patient teaching

Low-sodium diet, fluid restriction if ordered, daily weights, symptom recognition (sudden weight gain, worsening dyspnea), and medication adherence. Avoid NSAIDs, which cause sodium and water retention.