Right-Sided Heart Failure

Epidemiology and Etiology:

• Usually a consequence of left heart failure
• Pure right heart failure:
• Chronic severe pulmonary hypertension (cor pulmonale)

Common sites:

Gross features:

• hypertrophy and dilation of right ventricle and atrium
• acute – dilation without hypertrophy
• chronic – hypertrophy
• bulging of the ventricular septum to the left
• fibrous thickening of tricuspid valve (regurgitation)
• lungs:
• pleural effusions (particularly right)
• pericardial effusions
• liver and portal system:
• increased size and weight (congestive hepatomegaly)
• prominent passive congestion on cut section
• congested red centers of liver lobules surrounded by paler, sometimes fatty peripheral regions
• centrilobular necrosis
• ascites
• spleen:
• congested, enlarged (congestive splenomegaly)
• bowel:
• edema of wall
• peripheral edema of dependent portions of the body
• ankles
• pretibial
• presacral

Histologic features:

• liver:
• congested red centers of liver lobules surrounded by paler, sometimes fatty peripheral regions
• centrilobular necrosis
• sinusoidal congestion
• fibrosis of centrilobular areas (cardiac sclerosis or cardiac cirrhosis)
• spleen:
• sinusoidal dilation
• bowel:
• edema of wall

Immunophenotype:

Marker:

Sensitivity:

Specificity:

Molecular features:

Other features:

References:

• Robbins 2005