A patient after LVAD shows progressive dyspnea on exertion with signs of right-sided congestion. Which complication?

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

Answer: (B)

When an LVAD is in place, the left ventricle is unloaded and pressures fall, which often increases venous return to the right heart. If the right ventricle cannot handle this higher preload or becomes strained, it fails, leading to systemic venous congestion. That right-sided failure typically presents with symptoms like progressive dyspnea on exertion plus signs such as elevated jugular venous pressure, hepatomegaly, edema, and ascites. So this scenario points to right heart failure as the complication. Stroke would present with neurologic symptoms, device failure would cause pump-related issues and low-output signs rather than venous congestion, and depression is not a direct LVAD complication.