6 If left untreated, fluid retention increases demand on an already decompensated RV as indicated by increased jugular venous pressure (JVP) and can lead to increased dyspnoea, reduced mobility, sepsis, increased risk of developing lower limb cellulitis and deep vein thrombosis, and renal, intestinal and hepatic dysfunction. 6 As a result, the kidneys increase salt and water retention via activation of the arterial baroreceptor-mediated renin–angiotensin–aldosterone neuroendocrine system (RAAS). 7, 8 Despite total circulating volume being increased, renal blood flow is reduced because cardiac output is not sufficient to maintain the integrity of the arterial circulation. ![]() This leads to hepatic congestion, abdominal bloating (ascites), bowel congestion, and peripheral oedema 2, 5, 6 and has a major impact on morbidity and mortality in the PAH population. 3, 4 Right ventricular failure is associated with increased total blood volume (fluid overload), venous congestion, and systemic fluid retention. 1, 2 When the contractility of the RV can no longer compensate to maintain the cardiac output despite raised PVR, RV failure supervenes eventually leading to death. Pulmonary arterial hypertension (PAH) is a rare, progressive, chronic condition characterized by increased pulmonary vascular resistance (PVR), which elevates right ventricular (RV) afterload. This review provides an overview of the challenges related to fluid retention, including strategies to help patients manage symptoms and side effects of treatment. Fluid retention is often assessed and treated in clinical practice by specialist nurses, who act as a key patient contact providing advice and information on symptom management. All patients on diuretics should be regularly monitored for renal dysfunction and electrolyte imbalance and given advice on how to manage the side effects associated with diuretic use. Right heart failure can be treated with both pharmacological and non-pharmacological interventions to reduce fluid retention including altering fluid and salt intake, weight monitoring, and use of diuretics. If fluid overload develops, it is important to determine whether it is caused by the progression of PAH, a side effect of PAH-specific treatment, or another drug or comorbid condition, as this affects both the prognosis and the management strategy. Patients with RHF should be assessed regularly for signs of fluid retention. Vigilant management of RHF is important for maintaining patient quality of life, as fluid overload can lead to abdominal bloating (ascites) and peripheral oedema, which also has a major impact on patients’ morbidity and mortality. ![]() Our aim with this review is to provide practical advice and management support for nurses and other healthcare practitioners in managing fluid retention in adults with right heart failure (RHF) due to pulmonary arterial hypertension (PAH).
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