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Left Sided Heart Failure: What To Know

If a person has left sided heart failure, the left side of their heart does not fill with enough blood or pump it effectively. Left sided heart failure can lead to right sided heart failure.

Heart failure occurs when cardiac output is insufficient to circulate the blood the body needs.

Ejection fraction (EF) is a measurement of cardiac output. EF is the percentage of blood in the left ventricle that it can pump out with each contraction.

The target range for EF is 55–70%. If a person's left ventricle pumps less than 40% of its blood with each contraction, this may indicate heart failure.

Heart failure can occur on the left side of the heart, the right side, or both.

This article discusses left sided heart failure, including causes, diagnosis, treatment, and outlook.

There are two kinds of left sided heart failure.

For circulation to occur, the heart must be able to fill with blood, then pump it. Left sided heart failure can interfere with both filling and pumping.

Diastolic failure

Diastolic failure prevents the heart from filling with blood.

This is because the heart muscle has become too stiff for the left ventricle to relax properly between contractions, which is when filling usually occurs.

Diastolic failure is also known as heart failure with preserved ejection fraction (HFpEF).

Systolic failure

Systolic failure interferes with the heart's ability to pump blood.

It occurs when the left ventricle does not contract properly. This is also known as heart failure with reduced ejection fraction (HFrEF).

Because of the loss of proper left ventricle contraction, the heart pumps 40% EF or less. This is not enough to maintain adequate circulation throughout the body.

Left sided heart failure results in an accumulation of blood in the vessels that usually carry blood away from the lungs.

So, some symptoms may involve breathing, such as:

  • coughing, particularly during physical activity
  • shortness of breath
  • breathlessness while lying down or at nighttime

    • Other symptoms include:

  • leg swelling
  • increased abdominal width
  • weight gain
  • upper right torso pain
    • What is the primary symptom of left sided heart failure?

    According to the American Heart Association, shortness of breath (dyspnea) tops the list of the most common symptoms of heart failure.

    Dyspnea occurs most often during physical activity. It can also happen at night, prompting a person to get up from lying down to breathe more easily.

    Left sided heart failure risk factors include:

  • tobacco use
  • diabetes
  • overweight and obesity
  • low physical activity
  • being male
  • advanced age

    • Doctors can diagnose left sided heart failure in several ways.

    Physical exam

    Heart failure signs doctors look for include:

  • certain heart rhythm changes
  • sounds from fluid in the lungs
  • breathing problems from fluid around the lungs
  • bulging in the neck blood vessels
  • increased jugular vessel pressure from liver congestion
  • increased heart size
  • scrotal swelling
  • abdominal girth increase
  • rapid heart rate with low blood pressure
    • Blood tests

    Blood tests that can help identify heart failure include:

  • brain natriuretic peptide (BNP)
  • troponin T
  • basic metabolic panel
  • complete blood count (CBC)
  • liver function tests
    • Electrocardiogram (EKG)

    An EKG measures the heart's electrical activity and can detect abnormal heart rhythms. It can also identify whether the left ventricle is enlarged.

    Imaging tests

    Doctors also use imaging tests to look for signs of heart failure, including:

  • Coronary angiogram: A coronary angiogram checks the function of the blood vessels that bring oxygenated blood to the heart. Blockages in these vessels can lead to heart failure.
  • Echocardiogram: An echocardiogram is an ultrasound of the heart. It can measure EF, detect problems with ventricle contraction and relaxation, and detect other issues, such as valve abnormalities.
  • Chest X-ray: An X-ray uses ionizing radiation to create images of the structures inside the body.
  • CT scan: A CT scan is a type of X-ray that shows more detail because it uses a series of images instead of just one. CT scans can occur with or without contrast dye, depending on the scan's purpose.
  • MRI scan: Radio waves and magnetic energy from an MRI scanner create computerized imagery of the body.

    • Left sided heart failure has several treatments:

  • Lifestyle strategies and changes: Eating a low salt diet with plenty of vegetables and fruits, getting regular physical activity, and avoiding alcohol and smoking can help manage heart health.
  • Medications: Heart failure medications can slow the heart rate, reduce fluid and sodium levels, relax the blood vessels, and help the heart pump stronger.
  • Manage other health conditions: Treating and managing blood pressure and arrhythmias can help address factors that contribute to heart failure.
  • Implantable device: A person with an EF of less than 35% may benefit from an implantable cardioverter defibrillator (ICD) or pacemaker.
  • Transplantation: People with advanced heart failure may be eligible for a heart transplant.

    • Left sided heart failure can cause complications, including:

  • respiratory distress
  • interstitial fluid accumulation
  • arrhythmias
  • cardiogenic shock
  • pulmonary embolism
  • stroke
  • acute coronary syndrome
  • myocardium rupture

    • Left sided heart failure can also lead to death, but treating and managing it can extend a person's life.

    The outlook for left sided heart failure can vary. It can improve or become life threatening based on factors such as:

  • symptom severity
  • whether a person follows their treatment plan or makes recommended lifestyle changes
  • age
  • sex
  • underlying factors, such as blood pressure or kidney function

    • It is possible for a person to live 10 years or more after a heart failure diagnosis.

    The following lifestyle strategies may help prevent left sided heart failure:

  • regular exercise
  • high quality sleep
  • a diet that includes more fruits, vegetables, and whole grains and less salt
  • blood pressure management
  • not smoking
  • reducing and managing stress

    • Left sided heart failure can lead to weakness on the heart's right side.

    It is possible for right sided heart failure to occur on its own because of lung disease. However, most of the time, it starts from left ventricle problems.

    Is left sided heart failure worse?

    Left sided heart failure is worse and more common than right sided heart failure.

    Right sided heart failure impairs the heart's ability to pump blood to the lungs. Left sided heart failure reduces circulation in the entire body because the left ventricle is the heart's main pumping chamber.

    Left sided heart failure is the most common kind of heart failure. The left ventricle, where this heart failure begins, is the heart's strongest pumping chamber.

    Coronary artery disease and long-term unmanaged high blood pressure are the leading causes of left sided heart failure.

    Treatment includes lifestyle strategies, medications, implantable defibrillators or pacemakers, and transplant surgery, in severe cases.

    If a person follows their treatment plan, they can manage their heart failure and live for many years after their diagnosis.


    Types Of Heart Failure

    Heart failure is a chronic condition in which the heart cannot pump blood effectively. As a result, tissues and organs do not receive critical oxygen and nutrients.

    The heart is a complex organ, and there are various types of heart failure, including left-sided, right-sided, and congestive heart failure. A person may require different medications depending on the type of heart failure they have.

    This article explores the different forms of heart failure and potential treatments.

    Heart failure is a complex condition that doctors categorize into different types depending on:

  • the affected areas of the heart
  • the heart's pumping ability
  • underlying disease

    • For example, heart failure may affect the entire heart or only one side. The heart may have difficulty pumping enough blood around the body to support other organs and tissues, or the heart muscle may become stiff, blocking or reducing blood flow.

    Some people may experience acute heart failure, with symptoms suddenly appearing but resolving reasonably quickly. Other individuals develop chronic heart failure with long-term symptoms that do not improve.

    Understanding the types of heart failure is crucial for tailoring treatment approaches and improving a person's outcome.

    What is heart failure?

    Heart failure occurs when the heart's pumping ability has an impairment. It can result from various underlying causes, such as coronary artery disease or a heart attack.

    In heart failure, the heart muscles become weakened or stiff, leading to inadequate pumping of blood to meet the body's demands. It is a severe condition requiring immediate medical attention.

    Learn more about heart disease.

    The heart has two chambers on the left and two on the right. The left ventricle is responsible for most of the heart's pumping power, supplying oxygen-rich blood to the rest of the body.

    Left-sided heart failure is the most common form. When it occurs, the left side of the heart must work harder to pump the same amount of blood.

    According to the American Heart Association, a healthy left ventricle pumps around 55–60% of the blood it contains with each heartbeat. Doctors call this the ejection fraction.

    It states that there are two types of left-sided heart failure:

  • Systolic failure: This happens when the left ventricle does not contract normally, so it cannot pump blood with enough force to circulate it correctly. Doctors also call this heart failure with reduced ejection fraction, which means the heart pumps less than or equal to 40% of the blood it holds.
  • Diastolic failure: This occurs when the left ventricle loses its ability to relax properly. The muscle becomes stiff, and the heart cannot fill with blood properly during the resting period between beats. Doctors refer to this as heart failure with preserved ejection fraction, which means the heart is pumping greater than or equal to 50% of the blood it holds.

    • There is also a newer concept called heart failure with mid-range ejection fraction. In this type, the left ventricle pumps between 41–49% of the blood it holds.

    Learn about left-sided vs. Right-sided heart failure.

    As the heart pumps, it moves deoxygenated blood that has circulated around the body from the right atrium to the right ventricle and back to the lungs. In right-sided heart failure, the right ventricle becomes weakened or fails to function correctly.

    Right-sided heart failure typically happens due to left-sided failure, although it can occur on its own.

    If the left ventricle cannot pump enough blood from the heart, this increases fluid pressure back through the lungs, damaging the heart's right side. As a result, blood can back up in the veins, leading to fluid accumulation in organs and tissues throughout the body.

    Learn more about right-sided heart failure.

    Doctors may use the term "congestive heart failure" interchangeably with heart failure. It describes fluid accumulation that causes congestion in various parts of the body.

    When the heart cannot pump blood effectively, blood backs up in the veins, causing fluid congestion in the tissues. A person may then develop edema or swelling. This is particularly likely to occur in the legs and ankles, although it can happen elsewhere.

    Fluid collection in the lungs can interfere with breathing and cause shortness of breath. Doctors call this pulmonary edema.

    Heart failure also affects the kidneys, making them unable to excrete sodium and water effectively. As a result, blood volume increases, and the retained water contributes to soft tissue swelling.

    Learn more about congestive heart failure.

    Biventricular heart failure, which doctors also refer to as global heart failure, occurs when both the left and right ventricles of the heart are weak or fail to function correctly.

    This can lead to symptoms similar to left-sided and right-sided heart failure, including:

  • fluid retention
  • fatigue
  • shortness of breath

    • Heart failure can occur due to conditions that affect the heart's structure and function.

    These include:

    There is no cure for heart failure. However, the condition is manageable.

    Treatment for heart failure typically involves a combination of lifestyle modifications, medications, and medical procedures. Goals involve:

  • managing symptoms
  • slowing disease progression
  • improving quality of life
  • reducing the risk of complications
    • Lifestyle factors

    Lifestyle modifications may include:

  • dietary changes
  • regular exercise
  • weight management
  • quitting smoking, if applicable
  • sodium restrictions
  • fluid restrictions

    • Close monitoring by healthcare professionals is crucial. It is important for people to attend regular follow-up appointments to ensure optimal management of heart failure.

    Medications

    Doctors may prescribe the following to control symptoms and optimize heart function:

    Quad therapy, often used for treating heart failure, incorporates the above treatments.

    It is more challenging to pinpoint treatment for heart failure with preserved ejection fraction. Doctors commonly focus on managing blood pressure and fluid control to minimize further damage to the heart.

    Medical procedures

    In some instances, medical procedures may be necessary. This may involve the insertion of implantable devices such as pacemakers or defibrillators or surgical interventions such as coronary artery bypass grafting or valve repair or replacement.

    Doctors may consider a heart transplant for patients with severe heart failure at a very young age.

    An individual's outlook can vary depending on the severity and type of heart failure and their overall health.

    The mortality rate following hospitalization for heart failure is around:

  • 10% at 30 days
  • 22% at 1 year
  • 42% at 5 years

    • While heart failure is a severe and progressive condition, advancements in medical care have improved outcomes and extended life expectancy for many individuals.

    Heart failure is a complex condition that refers to the heart's inability to pump blood effectively, leading to symptoms and potential complications. It may affect either or both sides of the heart.

    Managing heart failure can involve a combination of lifestyle modifications, medications, and medical procedures. Doctors will aim to improve symptoms, slow disease progression, and enhance a person's quality of life.

    Regular monitoring and follow-ups with healthcare professionals are essential for optimal management and adjusting treatment plans as needed.


    I'm 50 And Want To Retire At 55 — What Should I Do?

    I'm 50 and would like to retire at 55. While I have a pension through work, I can only access it at 65. I own two rental properties – both will have their mortgages paid off by the time I'm 55. So I'm intending to live off the rental income if I retire then. The mortgage on my family home will also be paid off by the time I'm 55. Would you have any advice about how I can make sure to get myself into a financial position to retire at 55? Is there anything else I should do to prepare myself for an early retirement? And would it be a mistake to retire so early?Anon

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