Right-sided heart failure results from pulmonary hypertension, right ventricular myocardial infarction, or left-sided heart failure. The right ventricle cannot effectively pump blood to the lungs, which results in incomplete emptying of the right ventricle. The resulting decrease in forward blood flow causes blood to back up into the right atrium and then into venous circulation, resulting in venous congestion and increased venous pressure throughout the systemic circulation.

Clinical manifestations of right-sided heart failure include:

• Peripheral and dependent edema (eg, sacrum, legs, hands), especially in the lower extremities (Option 4).
• Jugular venous distension (Option 3).
• Increased abdominal girth due to venous congestion of the gastrointestinal tract (eg. hepatomegaly, splenomegaly) and ascites.
• Nausea and anorexia may also occur as a result of increased abdominal pressure and decreased gastrointestinal circulation (Option 2).
• Hepatomegaly due to hepatic venous congestion.

(Options 1 and 5) Orthopnea (dyspnea with recumbency), paroxysmal nocturnal dyspnea (PND), and crackles in lung bases are clinical manifestations of left-sided heart failure. Blood is not effectively pumped into systemic circulation, resulting in the backup of blood into the pulmonary vessels that causes congestion of the pulmonary vessels and, potentially, pulmonary edema. Pulmonary hypertension and right-sided heart failure typically present with dyspnea on exertion rather than orthopnea or PND.

Educational objective: In clients with right-sided heart failure, the heart cannot effectively pump blood to the lungs. Clinical manifestations result from systemic venous congestion and include peripheral edema, jugular venous distension, increased abdominal girth (hepatomegaly, splenomegaly), and ascites.