Heart Failure: Is It Left-Sided or Right-Sided, and Why It Matters

What is heart failure?

Your heart is a pump that works to pump blood through your body and when your ventricles are not functioning properly, they cause a back-up of fluid. This leads to left-sided heart failure, right-sided heart failure or both, known as biventricular failure.

By looking at your patient, you should be able to tell which type of HF they have!  If your patient is puffy with clear lungs, it’s most likely right sided.  If your patient has wet lungs with trouble breathing, it is most likely left-sided!

Treatment for Acute Heart Failure Exacerbation

What should you anticipate when caring for a patient with an acute exacerbation of their heart failure?

• Diuretics such as furosemide
  • First priority, especially if fluid overloaded
• Nitroglycerin
  • Decreases preload and myocardial workload
• BPAP (BiPAP)
  • Used if Type 2 Respiratory failure: hypercapnia & hypoxia
  • Reduces preload
• Dobutamine or Milrinone
  • Positive inotropes to improve contractility

Labs to follow:

In the acute exacerbation, you are off-loading fluid, reducing pre-load and afterload, and optimizing the heart’s ability to contract, helping blood move more efficiently through the heart! 

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