Left-Sided Heart Failure: Overview and More

Left-sided heart failure occurs when the left ventricle of the heart is unable to adequately pump blood to the rest of the body. This is the most prevalent type of heart failure and it becomes increasingly common as people age.

When the left side of the heart doesn't work properly, blood flow to the entire body can be reduced and there is a backup of blood in the pulmonary veins, which causes trouble breathing, fatigue, and, if left untreated, can eventually cause right-sided heart failure and death.

Types of Left-Sided Heart Failure

Left-sided heart failure can be further subcategorized. The two most common subtypes are left-sided heart failure with reduced ejection fraction and left-sided heart failure with preserved ejection fraction. Ejection fraction is the percentage of blood that the left ventricle is able to pump out with each contraction, or heartbeat.

In left-sided heart failure with reduced ejection fraction, the left ventricle becomes weak and is unable to contract forcefully enough to push blood through to the rest of the body.

In left-sided heart failure with preserved ejection fraction, the left ventricle stiffens and loses its ability to relax and fill with oxygen-rich blood coming from the lungs.

Left-Sided Heart Failure Symptoms

Symptoms of left-sided heart failure may include:

• Shortness of breath, particularly with exercise or when lying down
• Waking up during the night with difficulty breathing
• Swelling of the feet or legs (edema)
• Persistent coughing or wheezing
• Fatigue and weakness

Causes

Left-sided heart failure is caused by conditions that weaken or stiffen the muscle of the left ventricle, or that obstruct or overload blood flow through the left ventricle. The most common causes of left-sided heart failure include:

• High blood pressure (hypertension)
• Coronary artery disease and heart attacks
• Heart valve disease, especially aortic stenosis and mitral regurgitation

Other prominent causes of left sided heart failure include infections involving the heart muscle (such as viruses and Lyme disease), thyroid disease, kidney disease, autoimmune disease such as lupus, alcoholism, sleep apnea, and prolonged tachycardia (fast heart rate).

Risk Factors and Prevention

Risk factors for left-sided heart failure include:

• Diabetes
• Obesity
• Being biologically male
• Sedentary lifestyle
• Smoking

Not smoking, losing weight, and increasing your activity may help mitigate the risks. You may also help prevent left-sided heart failure if you:

• Limit alcohol intake
• Cut down on high-fat foods
• Avoid excessive salt intake
• Don't take recreational drugs
• Get enough sleep

Diagnosis

Your healthcare provider will take your medical history and report of symptoms, and conduct a physical examination. If you have left-sided heart failure, your practitioner may observe some of the following upon a physical examination:

• Decreased or abnormal lung sounds
• A distended jugular vein
• A distended abdomen
• Abnormal heart sounds
• Swelling in your feet or lower legs
• Low blood pressure
• Rapid heart rate

If your healthcare provider suspects you may have left-sided heart failure, they may order all or some of the following tests in order to confirm the diagnosis:

• Blood tests: Brain natriuretic peptide (BNP) or NT-proBNP, troponin, complete blood count (CBC), basic metabolic panel (BMP), liver function tests
• Electrocardiogram (EKG)
• Echocardiogram
• Coronary angiography 
• Cardiac catheterization
• X-rays, magnetic resonance imaging (MRI), or computerized tomography (CT) scans to help determine the size of the heart, etc.
• Stress test

Coronary Angiography and Cardiac Catheterization

A coronary angiography and cardiac catheterization are two diagnostic procedures often used to identify problems with the heart. It is a surgical procedure that involves a small incision made into the groin, arm, or neck and into a large blood vessel. A catheter is fed through the blood vessel, via the incision, to the heart.

The coronary angiography portion of this procedure involves the administration of a contrast dye (through the catheter and into the blood vessel). After you are given the contrast dye, the healthcare provider can take X-rays, which allow them to watch where the dye goes and observe its flow through the blood vessels and heart. This is helpful in identifying any blockages.

Other things can be done through a cardiac catheterization. Biopsies of tissue can be taken, stents can be placed to open up blockages, and the pressure of blood flow through the heart can be measured.

These tests are invasive procedures and are usually able to be done on a same-day surgery basis. Depending on where your incision is made and what is done during the procedure, you may need to lay flat for a period of time following your cardiac catheterization. You should follow your practitioner's or nurse's instructions precisely during your recovery period.

Treatment

If you are diagnosed with left-sided heart failure, your healthcare provider will take many things into consideration before developing a treatment regimen with your help. Factors that are usually considered include the underlying cause of your heart failure (if it can be identified), your lifestyle, and the severity of your condition.

Lifestyle changes such as modifying your diet, decreasing your sodium intake, increasing or changing your exercise levels, and reducing stress are often recommended. It's also recommended that people with heart failure avoid alcohol, smoking, and recreational drugs. Additionally, the following treatments may be used in the management of left-sided heart failure:

• High blood pressure medications (such as ACE inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors)
• Medications that decrease edema and remove extra fluid from the body, including diuretics and aldosterone antagonists
• Medications that help slow the heart rate, such as beta blockers or ivabradine
• SGLT2 inhibitors, such as Jardiance (empagliflozin), which are antidiabetic medications also used to treat cardiovascular disease
• Medications called inotropes, which affect the way the heart contracts
• Digoxin (only in severe cases)

Depending on your exact circumstances and what led to your heart failure, certain surgical procedures can be useful in treating it.

Left Ventricular Assist Device

A left ventricular assist device (LVAD) is a mechanical pump operated by a battery that's implanted via open-heart surgery. There are different types, but they all have four parts, including:

1. A pump that's put at the apex of the heart to receive blood
2. A tube that carries blood from the device to the aorta
3. A driveline that connects the pump to the system controller (going from the pump through the skin of your abdomen and to the system controller)
4. A system controller that is a computer and remains outside of your body

Heart Transplant

A heart transplant may be an option for a small number of people with severe left ventricular heart failure.

Limited donor hearts are available, though. Also, since many people with left heart failure are elderly and have other health problems, they may not be transplant candidates.

Prognosis

Left-sided heart failure is not typically cured but managed to improve your quality of life, keep the condition from worsening, and subsequently prolong life. In 2008, the mortality rate for heart failure was 18.2 per 100,000 men and 15.8 per 100,000 females. Many things factor into your prognosis, including the severity of your condition when diagnosed along with your gender, age, and adherence to your treatment regimen.

Coping

Finding a practitioner who specializes in this condition and is attentive to your needs will give you the best prognosis as well as help you to cope with your condition. Any illness that prevents you from participating in daily activities can lead to depression, so it is very important to discuss feelings of sadness with your healthcare provider. Adhering to your treatment regimens will help you to maximize your ability to engage in the activities you want to and keep your condition from worsening.

A good support system consisting of family and friends can be vital in helping you cope with left-sided heart failure. If you feel that your support system is lacking, please talk to your healthcare provider about additional resources such as a qualified therapist or support group.