A patient with LVAD complains of swelling in the legs and abdomen with limited physical activity tolerance. Which complication?

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

Answer: (B)

Right-sided heart failure causing systemic venous congestion is suggested by leg and abdominal swelling in an LVAD patient who has limited activity tolerance. The LVAD supports the left ventricle, but if the right ventricle can’t keep up with venous return, blood backs up into the systemic circulation. That increases venous pressures, leading to peripheral edema and ascites (abdominal swelling), and it reduces overall forward flow, which limits exercise tolerance and causes fatigue. This pattern is classic for RV failure in the setting of LVAD support.

Stroke would present with neurological symptoms, not edema or ascites. Depression relates to mood symptoms, not hemodynamics. Device failure or death would typically present with pump alarms, hypotension, dizziness, or sudden deterioration related to pump function, rather than a primary picture of venous congestion.