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Congestive heart failure occurs when the heart is unable to provide adequate perfusion to meet the metabolic requirements of peripheral tissues. Specifically in right-sided heart failure, the right ventricle loses its pumping function, and blood may back up into other areas of the body (Kumar, Abbas, & Aster, 2013). Most commonly left-sided heart failure leads to increased behind the left side of the heart that eventually causes the right side of the heart to fail (Hughes, 2009). Right-sided failure also can occur in patients with primary pulmonic or tricuspid valve disease, or congenital heart disease causing chronic volume and pressure overloads (Voelkel et al., 2006).
Coronary artery disease can cause left-sided heart failure leading to right-sided heart failure or can directly cause right-sided heart failure by blocking blood supply to the right ventricle. Chronic lung disease including emphysema, pulmonary embolism, and other causes of pulmonary hypertension, cause high blood pressure in the pulmonary arteries increases the workload of the right ventricle, eventually causing the right ventricle to fail (Albert, Trochelman, Li, & Lin, 2010). Cyanotic heart disease refers to a group of congenital heart defects that result in decreased oxygenation, often leading to CHF. Complications of an uncorrected atrial septal defects include pulmonary hypertension and right-sided heart failure, in addition to atrial fibrillation (Ren, 2010).
Right-sided heart failure typically is associated with very few respiratory symptoms. Typically, the clinical indicators are related to systemic and portal venous congestion, including liver and spleen enlargement, peripheral edema, pleural effusion, and ascites. Peripheral edema of dependent portions of the body, especially the lower extremities and pretibial edema, is a hallmark sign of right-side heart failure. In more severe cases, generalized massive edema or anasarca may be seen. Gastrointestinal symptoms, such as nausea, appetite loss, abdominal pain, may also be seen. It is very common for the patient to exhibit weight gain in spite of loss of appetite, usually related to fluid overload. Jugular venous distention may also be seen due to fluid overload (Albert et al., 2010).
Albert, N., Trochelman, K., Li, J., & Lin, S. (2010). Signs and symptoms of heart failure: Are you asking the right questions? American Journal of Critical Care, 19(5), 443–52.
Hughes, R. G. (2009). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AORN Journal. Rockville: Agency for Healthcare Research and Quality.
Kumar, V., Abbas, A. K., & Aster, J. C. (2013). Robbins Basic Pathology. Philadelphia; PA: Elsevier Saunders.
Ren, X. (2010). Cardiac Cirrhosis and Congestive Hepatopathy. Retrieved September 25, 2014, from
Voelkel, N. F., Quaife, R. a, Leinwand, L. a, Barst, R. J., McGoon, M. D., Meldrum, D. R., … Gail, D. B. (2006). Right ventricular function and failure: Report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. Circulation, 114(17), 1883–91.

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