Unifying Concepts

Manifestations of Right-Sided Heart Failure (RHF)

The diverse causes of right-sided heart failure (RHF) include, among others, primary cardiomyopathies with right ventricular (RV) involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease.

Manifestations of RHF

Clinical manifestations of RHF

  • Increased mortality
  • Fatigue/decreased functional capacity
  • Cardiorenal abnormalities
  • Cardiohepatic abnormalities
  • Protein malnutrition
  • Coagulopathy
  • Cachexia

Signs and symptoms

  • Elevated jugular venous pressure with prominent V wave
  • Peripheral edema
  • Bloating/early satiety/abdominal discomfort
  • Ascites and hepatomegaly
  • Pleural effusion
  • Prominent S2 (P2) (PH)
  • Right-sided S3 gallop
  • Holosystolic murmur LLSB (TR)
  • RV parasternal heave

LLSB indicates left lower sternal border; PH, pulmonary hypertension; RHF, right-sided heart failure; RV, right ventricular; and TR, tricuspid regurgitation.



  1. Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, Kociol RD, Lewis EF, Mehra MR, Pagani FD, Raval AN, Ward C; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular Disease in the Young; and Council on Cardiovascular Surgery and Anesthesia. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2018 May 15;137(20):e578-e622. [Medline]
  2. Houston BA, Brittain EL, Tedford RJ. Right Ventricular Failure. N Engl J Med. 2023 Mar 23;388(12):1111-1125. [Medline]


Created Dec 19, 2023.


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