Right ventricular failure refers to a cardiac problem that may arise in a person's lifetime. There is usually not enough blood flow to fill the right ventricle adequately or the right ventricle fails to eject the blood sufficiently to the rest of the body. This condition is fairly common and in the U.S. It is responsible for about 1 million hospital admissions per annum. Most of the patients requiring hospitalisation are adults over the age of 65.

What Are the Symptoms of Right Ventricular Failure?

Some common symptoms are:

• Unexplained fatigue that is a result of insufficient oxygenated blood flow to the various organs of the body
• Nausea and abdominal pain due to a backup of blood in the liver caused by the heart failure
• Peripheral oedema: swelling in the extremities of the body like the legs

These symptoms become evident because the increased blood pressure in the veins of the body.

What Causes Right Ventricular Failure?

There are a few common causes:

1. Left Sided Heart Failure

When the ventricle on the left underperforms, it can cause a build-up of deoxygenated blood in the veins returning from the body's organs like the lungs, liver and limbs. This insufficiency leads to a deficient blood flow into the right ventricle, causing it to fail over time.

2. Lung Disease

Certain chronic lung conditions such as emphysema can cause an increased blood pressure in the arteries of the lungs. This can force the right ventricle to work harder in order to pump blood to the rest of the body. Over time, this may cause right ventricular failure.

3. Narrowing of the Pulmonic Heart Valve

An insufficiently working heart valve can constrain the total blood flowing out of the right ventricle.

4. Narrowing of the Tricuspid Heart Valve

Limited blood flows out of the right atrium, causing it to enlarge and resulting in a backup of blood in the right ventricle.

5. Blocked Arteries

Narrowed arteries caused by plaque deposits will decrease the amount of blood flow to the heart. This blockage can occur either on the left side of the heart causing eventual right ventricular failure or directly in the blood vessels leading to the right ventricle itself.

6. Tricuspid Valve Insufficiency

When this valve fails to close properly, blood from the right ventricle flows backwards.

7. Pericardial Constriction

When the membrane enclosing the heart is exposed to chronic inflammation, it becomes thickened and harder. This restricts the heart muscle from pumping effectively.

8. Congenital Birth Defect

In this case, the person is born with an abnormal left-to-right shunt of blood in the heart. This causes blood to build-up in the right ventricle causing failure.

Tests and Diagnosis of Right Ventricular Failure

Your doctor will take a full medical history, including your family history and any underlying medical conditions that you may have. Your doctor may also make a record of all your symptoms and do a full physical examination. The physical examination will include listening for any sounds of congestion in your lungs or any anomalous heart sounds. Your jugular in the neck will be checked for any pressure build up that may have occurred in the legs or abdomen.

If your doctor suspects right ventricular failure, there are certain diagnostic tests he will order in order to confirm the diagnosis:

• Blood tests: thyroid, kidney and liver function will be tested as these are good indicators of how the heart is performing. The blood tests will also test for the presence of a certain chemical compound which is indicative of heart failure.
• X-ray: the chest area is x-rayed to see if the heart appears enlarged or if there is fluid in the lungs.
• Electrocardiogram (ECG): electrodes are attached to the skin of your chest and the electrical activity of the heart muscles is recorded. This will show up any anomalies with the heart rhythm.
• Echocardiogram: this type of test will be able to pinpoint exactly in which area the heart is not performing optimally. It uses sound waves to map out how the heart appears and how it is working. Any valve deformities will also be picked up.
• Stress test: this is performed while you're linked up to an ECG but you have a few physical movements to perform like running or walking. It can also include a breathing apparatus which will measure how you take in oxygen and expel carbon dioxide.
• CT or MRI scan: these specialised equipment takes images of your chest area to be examined by a specialist to diagnose any cardiac problems.
• Coronary angiogram: a catheter is inserted into a blood vessel in your groin or arm to reach the heart. A dye is injected so that images can be picked up by an x-ray. The resultant image shows the manner in which the heart and arteries are performing.
• Myocardial biopsy: a small sample of heart muscle is taken via a biopsy cord and examined to determine if the muscle is diseased.

How to Treat Right Ventricular Failure

As a first step, a lifestyle change is often recommended.Obese patients are encouraged to lose excess weight, alcohol in moderation and to stop smoking.

Medications will include:

• Diuretics to reduce the fluid build-up. The type prescribed will depend on how severe the fluid retention is.
• Medications to help regulate the heart’s workload like beta-blockers, etc.
• Digitalis may also be prescribed to enhance the contractions of the heart muscle.

Pacemakers may be implanted to synchronise the contractions of the ventricles.

Transplant: severe heart failure that fails to respond to treatment may need a transplant.