Editing Heart failure (section)

===Right-sided failure===
[[File:Combinpedal.jpg|thumb|upright=1.4|Severe peripheral pitting edema]]

Right-sided heart failure is often caused by [[pulmonary heart disease]] (cor pulmonale), which is typically caused by issues with [[pulmonary circulation]] such as [[pulmonary hypertension]] or [[pulmonic stenosis]]. Physical examination may reveal pitting peripheral edema, ascites, [[hepatomegaly|liver enlargement]], and [[splenomegaly|spleen enlargement]]. [[Jugular venous pressure]] is frequently assessed as a marker of fluid status, which can be accentuated by testing [[Abdominojugular test|hepatojugular reflux]]. If the right ventricular pressure is increased, a [[parasternal heave]] which causes the compensatory increase in contraction strength may be present.<ref name="ESC2016">{{cite journal | vauthors = Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P | title = 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC | journal = European Journal of Heart Failure | volume = 37 | issue = 27 | pages = 2129–2200 | date = 14 July 2016 | pmid = 27207191 | doi = 10.1093/eurheartj/ehw128 | doi-access = free | hdl = 2434/427148 | s2cid = 221675744 | url = https://academic.oup.com/eurheartj/article-pdf/37/27/2129/23748755/ehw128.pdf | type = Review | access-date = 7 February 2023 | archive-date = 7 February 2023 | archive-url = https://web.archive.org/web/20230207205925/https://academic.oup.com/eurheartj/article-pdf/37/27/2129/23748755/ehw128.pdf | url-status = live }}</ref>

''Backward'' failure of the right ventricle leads to congestion of systemic capillaries. This generates excess fluid accumulation in the body. This causes swelling under the skin ([[peripheral edema]] or [[anasarca]]) and usually affects the dependent parts of the body first, causing foot and ankle swelling in people who are standing up and [[Sacrum|sacral]] edema in people who are predominantly lying down. [[Nocturia]] (frequent night-time urination) may occur when fluid from the legs is returned to the bloodstream while lying down at night. In progressively severe cases, ascites (fluid accumulation in the abdominal cavity causing swelling) and liver enlargement may develop. Significant liver congestion may result in impaired liver function ([[congestive hepatopathy]]), jaundice, and [[coagulopathy]] (problems of decreased or increased blood clotting).<ref>{{Cite book | vauthors = Alcantara CA, Chandra A, Morvey D, von Schwarz ER |title=Right Heart Pathology |chapter=Acute Right Heart Failure |date=2018-01-03 |pages=215–225 |doi=10.1007/978-3-319-73764-5_10 |pmc=7123149|isbn=978-3-319-73763-8 }}</ref>