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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

Congestive heart failure - left

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:

  • Drinking too much alcohol
  • Heart attack
  • Heart muscle infections
  • High blood pressure
  • Hypothyroidism
  • Leaking or narrow heart valves
  • Any other disease that damages the heart muscle
  • Poor left-side heart function due to prior heart attacks

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

  • Cough (produces frothy or blood-tinged mucus)
  • Decreased urine production
  • Difficulty lying down; need to sleep with the head elevated to avoid shortness of breath
  • Fatigue, weakness, faintness
  • Irregular or rapid pulse
  • Sensation of feeling the heartbeat (palpitations)
  • Shortness of breath
  • Waking up due to shortness of breath (paroxysmal nocturnal dyspnea)
  • Weight gain from fluid retention

Symptoms in infants may include:

Exams and Tests

Physical examination may reveal an irregular or rapid heartbeat and increased breathing rate. The doctor may feel abnormal heart motion when touching the chest wall.

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 lower legs may be swollen and remain dimpled when pressed.

Tests may include:

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
  • Improve chances of survival

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

Treatment may involve:

  • Lifestyle changes such as stopping drinking alcohol
  • Medicines for high blood pressure
  • Surgery or cardiac catheterization to open blocked heart arteries

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

Medicines that may be used include:

  • Beta-blockers to prevent death in certain patients
  • Digitalis to help slow heart rhythms and increase the heart beat
  • Diuretics to help the body get rid of extra fluid
  • Spironolactone or epleronone to prevent salt retention and help patients with severe heart failure
  • ARBs, ACE inhibitors, long-acting nitrates, and hydralazine 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 a vein.

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.


Review Date: 9/23/2008
Reviewed By: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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