Left-sided heart failure

Definition

Left-sided heart failure is a life-threatening condition in which the left side of the heart cannot pump enough blood to the body.

Alternative Names

Causes

Heart failure may affect the right side, the left side, or both sides of the heart. The left side of the heart receives blood rich in oxygen from the lungs and pumps it to the remainder of the body. As the ability to pump blood forward from the left side of the heart is decreased, the remainder of the body does not receive enough oxygen especially when exercising. This results in fatigue.

In addition, the pressure in the veins of the lung increases, which may cause fluid accumulation in the lung. This results in shortness of breath and pulmonary edema.

Common causes of left-sided failure include the following:

• Heart attack
• Chronic blockages of the heart arteries
• High blood pressure
• Excessive alcohol consumption
• Leaking or narrow heart valves
• Hypothyroidism
• Heart muscle infections
• Any other disease that damages the heart muscle

In children, common causes include heart birth defects such as abnormal heart valves, abnormal blood vessel connections, or viral infections.

Left-sided heart failure occurs in approximately 1 to 3 of every 100 people and becomes more prevalent with age.

Symptoms

• Shortness of breath
• Difficulty lying down; need to sleep with the head elevated to avoid shortness of breath
• Sensation of feeling the heartbeat (palpitations)
• Irregular or rapid pulse
• Cough (produces frothy or blood-tinged mucus)
• Fatigue, weakness, faintness
• Weight gain from fluid retention
• Decreased urine production (oliguria)
• Infants may have poor feeding, weight loss, and failure to thrive

Exams and Tests

Physical examination may reveal an irregular or rapid heartbeat and increased rate of breathing. Listening to the heart may reveal heart murmurs or extra heart sounds, and listening to the lungs may reveal crackles or decreased breath sounds at the bottom. The skin of the legs may have excessive fluid and may remain dimpled when pressed.

Tests may include the following:

• Electrocardiogram (ECG) may show evidence of prior heart attack, an enlarged heart, or abnormal heart rhythm.
• Chest X-ray may show an enlarged heart and fluid in or around the lungs.
• Ultrasound of the heart (echocardiogram): poor pumping action of the heart, leaking or narrow heart valves.
• Blood tests to evaluate thyroid, liver, and kidney function.
• Stress test to evaluate for heart disease.
• Coronary angiography to evaluate blockages in the heart arteries.

Treatment

The goals of treatments are:

• Treat the disease that is causing the heart failure
• Reduce symptoms
• Relieve stress on the heart
• Reduce risks of worsening heart failure

You should see a heart specialist. You may need to stay in the hospital when symptoms are severe.

Treatment may involve surgery or cardiac catheterization to open blocked heart arteries, medicines for high blood pressure, and lifestyle changes such as stopping drinking alcohol.

Persons with heart failure should eat less salt, avoid alcohol, and exercise moderately.

Medicines that may be used include:

• Diuretics such as furosemide (Lasix) or spironolactone (Aldactone) to help the body get rid of extra fluid
• Beta blockers and ACE inhibitors to reduce the stress on the heart and to prevent further muscle damage and scarring
• Digoxin to increase muscle strength and slow down abnormally fast heart rates

In severe cases, medicines are given through an IV (intravenous) line in your arm.

When heart function decreases significantly, a defibrillator may be recommended to prevent sudden cardiac death. A defibrillator is used to prevent dangerous heart rhythms, which often occur in people with very weak hearts.

A number of studies have shown that heart failure symptoms can be improved with a special type of pacemaker. It paces both the right and left sides of heart. This is referred to as biventricular pacing or cardiac resynchronization therapy. Ask your provider if you are a candidate for this.

In very severe cases, when medicines alone do not work, a heart pump (ventricular assist device) can be implanted. A heart transplant may be needed.

Outlook (Prognosis)

Heart failure is a serious condition that can result in early death. How well a person does depends on the cause of the heart failure, as well as the person's age and ability to tolerate exercise.

In many cases, there is little chance that the heart will fully recover. However, many forms of heart failure are well controlled with medication and the condition can remain stable for many years with only occasional flare ups of symptoms.

Possible Complications

• Pulmonary edema
• Total failure of the heart to function (circulatory collapse)
• Abnormal heart rhythms
• Side effects of medications
  • Low blood pressure (hypotension)
  • Lightheadedness, fainting
  • Headache
  • Chronic cough
  • Low electrolyte levels
  • Difficulty with sexual intercourse

When to Contact a Medical Professional

Call your health care provider if symptoms indicating congestive heart failure occur.

Call your health care provider or get to the emergency room if symptoms are severe or if you experience chest pain, weakness, fainting, rapid or irregular heartbeat, increased cough or sputum production, sudden weight gain, or swelling.

Call your baby's health care provider if the infant has weight loss, poor feeding, or does not appear to be growing or developing normally.

Prevention

Follow your health care provider's advice for treatment of conditions that may cause congestive heart failure. Follow dietary guidelines and minimize or eliminate smoking and alcohol consumption.