Right heart failure is a major complication of pulmonary hypertension. In patients with pulmonary hypertension, right heart failure will occur sooner or later and will develop as pulmonary hypertension persists. The term right heart failure refers to the inability of the right ventricle to pump sufficient blood to the pulmonary circulation, resulting in insufficient blood volume in the arterial system of the patient’s body circulation and obstruction of return flow in the venous system. It manifests as hypotension, insufficient blood perfusion to the heart, brain, kidneys and other important organs, especially the kidneys, with increased urea nitrogen, creatinine and uric acid; body circulation stasis manifests as abdominal distension, poor nausea, sunken swelling of the lower limbs, and even ascites. There are many causes of right heart failure, such as right ventricular myocardial infarction, right ventricular cardiomyopathy, severe tricuspid regurgitation, and right heart volume overload. Pulmonary hypertension is the most important, and most difficult to treat, cause of right heart failure. In patients with pulmonary hypertension, the contractility of the right ventricle gradually decreases due to its long-term overload, which in turn leads to the enlargement of the right ventricular intraventricular meridian, the increase of the right ventricular end-diastolic pressure, and finally the increase of the right atrial pressure and the obstruction of venous blood return in the body circulation, thus causing the typical symptoms of right heart failure. Therefore, the most important treatment for right heart failure due to pulmonary hypertension is first to reduce the pulmonary artery pressure. Only when the pulmonary artery pressure decreases, the burden on the right ventricle can be reduced and the contractility of the right ventricle can be restored, thus the symptoms of right heart failure can be eliminated. Significant advances have been made in recent years in the pharmacological lowering of pulmonary artery pressure. Patients who were previously thought to be hopeless have been treated with significant improvements in quality of life and a significant increase in life expectancy. Even some patients with severe pulmonary hypertension who developed a body-pulmonary shunt with preexisting heart disease have been treated and their condition re-evaluated, resulting in surgical opportunities and a new life for the patient. Current drugs with proven efficacy include: prostacyclin analogs such as epoprostenol, iloprost, and travoprost; type 5 phosphodiesterase inhibitors such as sildenafil, vardenafil, and tadalafil; and endothelin receptor antagonists such as bosentan, andrisentan. Some new drugs will be available soon, such as guanylate cyclase direct agonists; prostacyclin receptor agonists, etc. The second most important treatment for right heart failure due to pulmonary hypertension is to maintain fluid balance. Too little fluid entering the body will aggravate the circulating blood volume deficiency and at the same time aggravate the renal insufficiency, while too much fluid will aggravate the heart burden and at the same time aggravate the venous stasis. The general principle is that the total daily fluid intake of patients with right heart failure should be about 2000 ml, and attention should be paid to the amount of outgoing for incoming. If the output is too small, the amount of diuretic should be increased; if the output is too large, attention should be paid to replenishment the next day. Diuresis is often a very difficult problem in patients with right heart failure, and there are several points to note: 1) diuretics are definitely ineffective when blood pressure is too low, so it is necessary to apply antihypertensive drugs at the same time; 2) diuretics are ineffective when hyponatremia and hypoproteinemia are present, so they must be corrected at the same time; 3) thiazide diuretics and tab diuretics are used in large quantities and the combination of the two can sometimes achieve unexpected results; 4) large amounts of furosemide intravenous drip The effect is often better than intravenous push; 5) Hypokalemia is bound to occur when diuretics are used in large quantities, so attention must be paid to potassium supplementation. The amount of supplementation should be determined by the amount lost. However, the quality of domestic potassium supplementation slow-release tablets is unreliable and the absorption and utilization rate are low, so it is necessary to figure out the dosage according to the laboratory results; long-term application of a diuretic can produce resistance to it, so it is recommended to alternate the application of furosemide, hydrochlorothiazide, bumetanide, etc. The third aspect of treatment for right heart failure due to pulmonary hypertension is cardiac stimulant therapy, but the effect of cardiac stimulants is far less than that of treating left heart failure. When there is a decrease in right ventricular contractility and rapid-type supraventricular arrhythmias (such as atrial fibrillation), cardiac-strengthening drugs of the digitalis class can be applied with better results. Long-term administration of digoxin 0.125 mg once a day is safe. In case of exacerbation, milrinone, levosimendan, etc. can be applied under close observation during hospitalization, but it is important to pay attention to arrhythmia and hypotension. The fourth aspect of treatment of right heart failure due to pulmonary hypertension is to avoid rigidly adapting the treatment of left heart failure. beta-blockers and angiotensin receptor antagonists are the most important measures in the treatment of left heart failure, but their use in this group of patients is dangerous. Careful application of angiotensin receptor antagonists may be beneficial in patients who do not have low blood pressure, but it is important to ensure that blood pressure is not lowered too low. Nitrates are effective in the treatment of left heart failure, but are not recommended in this group of patients because they can exacerbate hypotension and increase stasis in the circulation, while the effect of lowering pulmonary pressure is almost negligible. Intravenous application of vasodilators such as phentolamine is more harmful than beneficial. The fifth aspect of treatment for right heart failure due to pulmonary hypertension is daily health care. Be sure to prevent colds and treat them promptly; insist on doing activities that are within your ability, but do not overdo it; face life with a positive attitude and be hopeful for the future.