Chronic Right Heart Failure: Recognizing the Key Symptoms and Signs

Chronic right heart failure is often the result of underlying pulmonary conditions such as chronic obstructive pulmonary disease (COPD), bronchial asthma, or chronic interstitial lung disease. These conditions place increased strain on the right side of the heart, eventually leading to its gradual dysfunction. Understanding the symptoms and signs of chronic right heart failure is crucial for timely diagnosis and effective management.

Common Symptoms of the Primary Lung Disease

The initial signs usually stem from the underlying lung disorder. Patients may experience persistent coughing, excessive mucus production, and shortness of breath, especially during physical exertion. These symptoms tend to worsen over time and are often the first indicators of a more serious underlying condition affecting both the lungs and the heart.

Signs and Symptoms of Right Heart Failure

As the right heart begins to fail, systemic venous congestion becomes apparent. This can lead to a variety of non-specific but significant symptoms, including fatigue, reduced appetite, nausea, vomiting, and abdominal bloating. These occur due to fluid buildup in the abdomen and congestion of the gastrointestinal tract. Additionally, patients may notice a decrease in their ability to tolerate physical activity and worsening breathlessness, even at rest.

Distinctive Physical Signs of Chronic Right Heart Failure

Visible and Detectable Indicators

Several key physical signs help clinicians diagnose chronic right heart failure. These include jugular venous distension, where the neck veins appear visibly swollen due to increased pressure in the venous system. A positive hepatojugular reflux test is another important diagnostic clue.

Organ Involvement and Fluid Accumulation

Enlargement of the liver and spleen is commonly observed, along with the accumulation of fluid in multiple serous cavities — a condition known as pleural effusion (fluid around the lungs), ascites (fluid in the abdominal cavity), and pericardial effusion (fluid around the heart). These fluid accumulations can lead to additional symptoms and complications.

Peripheral Edema and Other Findings

One of the most recognizable signs is pitting edema in both lower limbs, where pressing on the swollen area leaves a temporary indentation. Additionally, shifting dullness — a clinical sign indicating the presence of free fluid in the abdomen — may be detected during a physical examination.