Adverse effects of tyrosine kinase inhibitors in cancer therapy: pathophysiology, mechanisms and clinical management
What Is Right-side Heart Failure?
When your heart is strong, it pumps blood throughout your body. But when you have heart failure, the muscles in your heart walls slowly weaken. Once they're too weak, your heart can't pump the blood that your body needs.
And heart failure is so common. It's one of the main reasons people age 65 and older are admitted to the hospital. It can happen on either the right or left side of your heart. But what difference does it make which side is affected?
When your heart is working normally, it pumps oxygen-rich blood through your lungs and to the rest of your body. The left ventricle, or left chamber, of the heart provides most of the heart's pumping power. So when you have left-side heart failure, your heart can't pump enough blood to your body.
The right ventricle, or right chamber, moves "used" blood from your heart back to your lungs to be resupplied with oxygen.
So when you have right-side heart failure, the right chamber has lost its ability to pump. That means your heart can't fill with enough blood, and the blood backs up into the veins. If this happens, your legs, ankles, and belly often swell.
Sometimes it just happens. But usually it's left-side heart failure that causes right-side heart failure. As the left chamber of your heart loses some of its ability to pump, blood continues to back up -- sometimes into your lungs.
Heart failure is a long-term condition that gets worse over time. In most cases, you get it because you have other health issues that have damaged or weakened your heart.
Some other causes of right-side heart failure include:
Coronary artery disease. This is the most common form of heart disease and cause of heart failure. When you have coronary artery disease, plaque blocks your arteries, causing blood flow to your heart muscle to slow or even stop. Read more on clogged arteries and the causes of arterial plaque.
High blood pressure. It measures how hard your heart pumps blood through your arteries. The higher your blood pressure, the harder your heart is working to pump it. That means over time, your heart muscles can thicken and weaken because of the extra work they do. Learn about the symptoms of high blood pressure.
Damaged heart valves. Valves keep blood flowing in the right direction through your heart. If they get damaged, by an infection or heart defect, for instance, your heart has to work harder to pump blood. Eventually, it will become weakened. Get more information on heart valve disease symptoms and causes.
Congenital heart defects. Some babies are born with problems in their heart structure. If you were, it could increase your odds of heart failure. Read about the most common congenital heart condition, ventricular septal defect.
Arrhythmia. This is when your heart has an irregular heartbeat. It may beat too fast, too slow, or just not the way it should. Most of the time, arrhythmia is harmless. But it can also make your heart pump an insufficient amount of blood through the body. If it's not treated, it could weaken your heart over time. View a slideshow on the different causes of heart palpitations.
Lung disease. Over time, problems in the lungs cause the right side of the heart to enlarge and fail. Your doctor may call this "cor pulmonale." Find out more on the link between heart failure and lung disease.
Other long-term health conditions. Diabetes, HIV, and thyroid problems are examples of health issues that do not go away and eventually could play a part in heart failure.
Your feet, legs, and ankles will likely swell because blood is backing up in your veins. This symptom is called edema.
As your heart failure gets worse, you may also see some of these symptoms:
There is no cure for heart failure, but there are treatments for its symptoms. Talk to your doctor. They may suggest medications to make you more comfortable. In some cases, a procedure or surgery may be necessary.
Your doctor will also suggest you do some things differently to reduce the stress on your heart. These might include:
Heart failure happens over time. But if you see your doctor and make some changes, you may stop the damage and get on with living a strong, happy life.
Type 2 Diabetes Patients With Coronary Disease Face Higher Mortality, Poorer Right Ventricular Function: Study Shows
China: Patients living with type 2 diabetes mellitus (T2DM) who also suffer from obstructive coronary artery disease (OCAD) are at a significantly increased risk of mortality and hospitalization due to heart failure, according to a new study published in Cardiovascular Diabetology.
The research, conducted by Dr. Jin Wang and colleagues from the Department of Radiology at West China Hospital, Sichuan University, used advanced cardiac imaging to investigate the link between right ventricular (RV) function and clinical outcomes in these high-risk patients.
"Patients with type 2 diabetes and OCAD faced a 1.91-fold higher risk of death and heart failure hospitalization compared to those without OCAD," the researchers reported. "Right ventricular strain parameters, including global longitudinal and circumferential peak strain, showed a stepwise decline from healthy controls to diabetics without OCAD, and further in those with OCAD. OCAD emerged as a strong predictor of adverse clinical outcomes."
The study analyzed data from 246 individuals with T2DM—105 with OCAD and 141 without—and compared them to 85 healthy controls. Using cardiovascular magnetic resonance (CMR), the researchers assessed RV structure and function, with a particular focus on myocardial strain parameters such as peak strain (PS) and strain rates during both systolic and diastolic phases.
The following were the key findings of the study:
The study highlights the value of CMR feature-tracking (CMR-FT) in detecting subtle but clinically significant impairments in RV function, especially in diabetic patients with coexisting coronary disease. According to the authors, identifying these impairments early could help refine risk stratification and guide more personalized management strategies.
"The combination of type 2 diabetes and obstructive coronary artery disease not only accelerates cardiac dysfunction but also significantly worsens prognosis," the researchers concluded. "Assessing right ventricular function with CMR may provide critical insights into patient outcomes and inform more effective interventions."
The study highlights the need for heightened cardiovascular monitoring in diabetic populations, particularly those with known coronary involvement. As the prevalence of diabetes continues to rise globally, these findings could contribute to more targeted approaches to preventing heart failure and reducing mortality in this vulnerable group.
Reference:
Wang, J., Yan, WF., Shi, K. Et al. Comparison of right ventricular function and clinical outcomes in type 2 diabetes patients with and without obstructive coronary artery disease: insights from a CMR study. Cardiovasc Diabetol 24, 229 (2025). Https://doi.Org/10.1186/s12933-025-02755-z
Heart Failure And Biventricular Pacemakers
In the normal heart, the lower chambers (ventricles) pump at the same time and in sync with the heart's upper chambers (atria).
When a person has heart failure, often the right and left ventricles do not pump together. And when the heart's contractions become out of sync, the left ventricle is not able to pump enough blood to the body.
This eventually leads to an increase in heart failure symptoms, such as shortness of breath, dry cough, swelling in the ankles or legs, weight gain, increased urination, fatigue, or rapid or irregular heartbeat.
Cardiac resynchronization therapy (CRT), also called biventricular pacing, uses a special kind of pacemaker -- a biventricular pacemaker -- that is designed to help the ventricles contract more normally. It keeps the right and left ventricles pumping together by sending small electrical impulses through the leads.
This therapy has been shown to improve the symptoms of heart failure and overall quality of life in certain patients with severe symptoms that aren't controlled with medication.
Leads are tiny wires implanted through a vein into the right ventricle and into the coronary sinus vein to pace or regulate the left ventricle. Usually (but not always), a lead is also implanted into the right atrium. This helps the heart beat in a more balanced way.
Traditional pacemakers are used to treat slow heart rhythms. Pacemakers regulate the right atrium and right ventricle to maintain a good heart rate and keep the atrium and ventricle working together. This is called AV synchrony. Biventricular pacemakers add a third lead to help the left ventricle have a normal contraction when it also doesn't function properly.
Biventricular pacemakers improve the symptoms of heart failure in about 50% of people that have been treated with medications but still have severe or moderately severe heart failure symptoms. Therefore, to be eligible for the biventricular pacemaker, heart failure patients must:
In addition, the heart failure patient may or may not need this type of pacemaker to treat slow heart rhythms and may or may not need an internal defibrillator (implantable cardioverter defibrillator, or ICD), which is designed to treat people at risk for sudden cardiac death or cardiac arrests.
People with heart failure who have poor ejection fractions (measurement that shows how well the heart pumps with each beat) are at risk for fast irregular heart rhythms -- some of which can be life-threatening -- called arrhythmias. Currently, doctors use an ICD to prevent these dangerous rhythms. The device works by detecting such a rhythm and shocking the heart back to normal.
These devices can combine biventricular pacing with anti-tachycardia pacing (to slow down the heart rate) and internal defibrillators (ICDs) to deliver shocks as needed. Current studies are showing that resynchronization may even lessen the amount of arrhythmia that occurs, decreasing the times the ICD needs to shock the heart. These devices are improving heart failure patients' quality of life as well as improving their safety.
Ask your doctor what medications you are allowed to take before your pacemaker is implanted. Your doctor may ask you to stop certain drugs several days before your procedure. If you have diabetes, ask your doctor how you should adjust your diabetic medications.
Do not eat or drink anything after midnight the night before the procedure. If you must take medications, drink only small sips of water to help you swallow your pills.
When you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry and valuables at home.
Pacemakers can be implanted two ways:
Inside the heart (endocardial, transvenous approach): This is the most common and simple technique used. A lead is placed into a vein (usually under your collarbone), and then guided to your heart. The tip of the lead attaches to your heart muscle. The other end of the lead is attached to the pulse generator, which is placed under the skin in your upper chest. This technique is done under local anesthesia (you will not be asleep).
Outside the heart (epicardial approach): Your chest will be opened and the lead tip is attached to the outside of the heart. The other end of the lead is attached to the pulse generator, which is placed under the skin in your abdomen. This technique is done under general anesthesia (you will be asleep) by a surgeon.
Your doctor will decide which approach is best for you, although almost all patients receive the transvenous approach.
Hospital stay: After the pacemaker implant, you will be admitted to the hospital overnight. The nurses will monitor your heart rate and rhythm. You will also have a monitor (a small recorder that is attached to your chest by small electrode patches). It will record your heart rhythm while you are in the hospital. This is another way to check proper pacemaker function. The morning after your implant, you will have a chest X-ray to check your lungs and the position of your pacemaker and leads. Your pacemaker will be checked to make sure it's working properly. The results of the test will be reported to your doctor.
Pacemaker check: For your pacemaker check, a small machine known as a programmer is used to check your pacemaker. It has a wand that is placed directly over the device. This machine allows the technician to read your pacemaker settings and make changes during testing. With these changes, the function of the pacemaker and leads can be evaluated. You may feel your heart beating faster or slower. This is normal; however, report all symptoms to the technician. Results of the pacemaker check are discussed with your doctor who will then determine your pacemaker settings.
After your pacemaker check, an echocardiogram may be done to check your heart function to look for improvement with your new pacemaker.. The technician nurse will be there during your echo and will change your pacemaker at least three times. The echo will be repeated with each change to evaluate heart function. The pacemaker will keep the settings that demonstrated your best heart function.
Usually, you will be able to go home the day after your pacemaker is implanted. Your doctor will discuss the results of the procedure and answer any questions you may have. A doctor or nurse will go over specific instructions for your care at home. Please ask a responsible adult to drive you home. You may not drive for at least 3 weeks after a pacemaker.
Keep the area where the pacemaker was inserted clean and dry. After about five days, you may take a shower. Look at your wound daily to make sure it is healing. Call your doctor if you notice:
After your pacemaker is implanted, you may move your arm normally and do not have to restrict its motion during normal daily activities. Avoid extreme pulling or lifting motions (such as placing your arm over your head without bending at the elbow). Activities such as golf, tennis, and swimming should be avoided for six weeks after the pacemaker is implanted. Microwave ovens, electric blankets, and heating pads may be used. Cellular phones should be used on the side opposite your pacemaker. Ask your doctor or nurse for more specific information regarding types of equipment that may interfere with your pacemaker.
Pacemaker Identification: You will receive a temporary ID card that tells you what type of pacemaker and leads you have, the date of implant and the doctor who implanted it. In about three months following implantation, you will receive a permanent card from the company. It is important that you CARRY THIS CARD AT ALL TIMES in case you need medical attention at another hospital.
A complete pacemaker check should be done six weeks after your pacemaker is implanted. This check is very important, because adjustments will be made that can prolong the life of your pacemaker. After that, your pacemaker should be checked every six months using a telephone transmitter to evaluate battery function. The nurse will explain how to check your pacemaker using the telephone transmitter. When the battery gets low, you will need to replace the pacemaker.
A follow-up pacemaker check is scheduled every three to six months. This check differs from the telephone check because the leads are also tested. Leads cannot be checked thoroughly over the telephone.
Here is an outline of the pacemaker follow-up schedule:
Pacemakers usually last five to fifteen years. Biventricular pacemakers that are combined with an ICD do not tend to last as long. The lifespan of the pacemaker depends on how much your heart is depending on it.
After getting a pacemaker, you will need to follow-up with the doctor and nurses in a pacemaker clinic and through phone check-ups. This will allow them to monitor your pacemaker's function and anticipate when it will need to be changed. In addition, the pacemaker may be programmed to beep when the battery is low. Your doctor will demonstrate this beep for you.
Resynchronization therapy is only one part of a comprehensive heart failure management program. Device and/or surgical therapy, when combined with taking medications, following a low-sodium diet, making lifestyle changes, and following up with a heart failure specialist, will help you decrease symptoms and live a more active life. Your doctor will help determine what treatment options are best for you.
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