A patient with an LVAD shows elevated JVP, peripheral edema, and hepatic congestion, with preserved left-ventricular function. Which complication is likely?

A patient with an LVAD shows elevated JVP, peripheral edema, and hepatic congestion, with preserved left-ventricular function. Which complication is likely?

• A. Stroke
• B. RH failure
• C. Depression
• D. Device failure/death

Answer: (B)

Unloading the left ventricle with an LVAD lowers left-sided pressures and increases venous return to the right heart. If the right ventricle cannot handle that increased preload or is already impaired, it fails to pump effectively, leading to systemic venous congestion. That explains the elevated JVP, peripheral edema, and hepatic congestion even though left-ventricular function is preserved thanks to the LVAD. This pattern points to right-sided heart failure as the complication. Stroke would typically present with neurological symptoms rather than venous congestion, and device failure/death would more likely show inadequate pump function, low flows, or device alarms rather than isolated signs of systemic congestion. Depression is not a cardiac complication.

Unloading the left ventricle with an LVAD lowers left-sided pressures and increases venous return to the right heart. If the right ventricle cannot handle that increased preload or is already impaired, it fails to pump effectively, leading to systemic venous congestion. That explains the elevated JVP, peripheral edema, and hepatic congestion even though left-ventricular function is preserved thanks to the LVAD. This pattern points to right-sided heart failure as the complication.

Stroke would typically present with neurological symptoms rather than venous congestion, and device failure/death would more likely show inadequate pump function, low flows, or device alarms rather than isolated signs of systemic congestion. Depression is not a cardiac complication.