A LVAD patient experiences abdominal and leg edema with signs of venous congestion. Which complication?

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

Answer: (B)

Abdominal and leg edema with venous congestion in an LVAD patient points to right-sided heart failure. The LVAD unloads the left ventricle and can improve forward flow, but if the right ventricle cannot handle the increased venous return or if there is preexisting RV dysfunction, pressures back up into the systemic veins. This causes elevated central venous pressure with manifestations like abdominal distention, ascites, hepatomegaly, and peripheral edema. Stroke would present with focal neurological deficits, depression isn’t a cardiac complication, and device failure/death would typically show pump-related hemodynamic collapse or alarms rather than isolated venous congestion.