Spread the love

Right-Sided Heart Failure USMLE Notes & Mnemonics contains all the high-yield points you need to know.


  • Right-Sided Heart Failure: Occurs when the right ventricle fails to pump efficiently, leading to a backup of blood in the venous system and reduced forward blood flow.


  • Often secondary to left-sided heart failure.
  • Primary causes include chronic lung diseases (cor pulmonale), pulmonary hypertension, valvular heart disease (tricuspid or pulmonic valve), congenital heart defects. (Ref)


  • Impaired right ventricular function → increased venous pressure → systemic venous congestion.

Clinical Features:

  • Jugular Venous Distension (JVD): Increased venous pressure visible in the neck.
  • Peripheral Edema: Swelling of the ankles and feet.
  • Ascites: Accumulation of fluid in the abdomen.
  • Hepatomegaly: Liver enlargement; may progress to congestive hepatopathy.
  • Anorexia and Nausea: Due to congestive hepatopathy and GI congestion.
  • Fatigue and Weakness: From reduced cardiac output.


  • Echocardiogram: Assess ventricular function, valvular heart disease, pulmonary pressures.
  • Chest X-Ray: May show enlarged cardiac silhouette, pulmonary congestion.
  • BNP/NT-proBNP Levels: Elevated in heart failure.
  • ECG: May show evidence of right ventricular hypertrophy or strain.


  • Treat Underlying Cause: E.g., management of left-sided heart failure, pulmonary hypertension.
  • Diuretics: To reduce fluid overload.
  • Salt and Fluid Restriction: To reduce fluid retention.
  • Oxygen Therapy: For hypoxemia.
  • Positive Inotropic Agents: In severe cases (e.g., digoxin).
  • Vasodilators and ACE Inhibitors: Used cautiously due to potential for reducing right ventricular preload.


  • Right ventricle dysfunction
  • Increased venous pressure
  • Girth increase (ascites, edema)
  • Hepatomegaly
  • Tricuspid valve disease (commonly involved)
  • Fatigue
  • Anorexia/nausea
  • Increased JVD
  • Less oxygenation (hypoxemia)
  • Underlying lung disease (cor pulmonale)
  • Reduced cardiac output
  • Edema (peripheral)

Chart: Key Features and Management of Right-Sided Heart Failure

FeatureDescriptionManagement Strategy
Jugular Venous DistensionVisible neck vein distensionDiuretics, salt/fluid restriction
Peripheral EdemaSwelling in ankles and feetDiuretics, elevation of limbs
AscitesFluid in abdomenDiuretics, salt/fluid restriction
HepatomegalyEnlarged liverTreat underlying cause
Echocardiogram FindingsReduced RV function, valve abnormalitiesGuided medical therapy

Note: In USMLE, focus on recognizing the signs and symptoms of right-sided heart failure, understanding its pathophysiology, especially when secondary to left-sided heart failure or pulmonary pathology, and knowing the general principles of management. The role of diuretics in managing fluid overload is particularly important.

Check other important USMLE Notes

Spread the love
Pin It
error: Content is protected !!