Left sided heart failure happens when the heart has to remodel itself after systemic changes. Like, if you have hypertension, are anemic, have a metabolic derangement, or an aortic valve stenosis, the left ventrical hypertrophies like any muscle in order to contract with greater force. This is obviously an oversimplification. Right sided heart failure usually comes after this because blood fills the left ventrical less efficiently over time as a result of this remodelling. You get a backup from the left and the right has to hypertrophy in a similar way to deal with this backup. In other settings, high blood pressure I’m the pulmonary vasculature can cause isolated right heart failure. There are other conditions (COPD), especially congenital ones, that can cause isolated right heart failure.
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