Left-Sided Heart Failure
Baptist Health is known for advanced, superior care for patients with heart disease and the diagnosis, management and treatment of left-sided heart failure. The American Heart Association awarded us with the Get With the Guidelines® Bronze Award in 2016 for consistent application of quality measures in treating heart failure.
What is Left-Sided Heart Failure?
There are two different types of left-sided heart failure. Left-sided heart failure is a heart condition where the muscle on the left side of the heart is diminished and the pump doesn't work to the body. Left-sided heart failure is defined not as a disease, but a process. Left-sided heart failure occurs when the left ventricle, the heart’s main pumping power source, is gradually weakened. When this occurs, the heart is unable to pump oxygen-rich blood from the lungs to the heart’s left atrium, into the left ventricle and on through the body and the heart has to work harder.
Systolic failure with reduced ejection fraction (HFrEF)
Systolic failure occurs when the left ventricle cannot contract forcefully enough to keep blood circulating normally throughout the body, which deprives the body of a normal supply of blood. As the left ventricle pumps harder to compensate, it grows weaker and thinner. As a result, blood flows backwards into organs, causing fluid buildup in the lungs and/or swelling in other parts of the body.
Diastolic heart failure with preserved ejection fraction (HFpEF)
Diastolic heart failure occurs when the left ventricle has grown stiff or thick, and it is unable to fill the lower left chamber of the heart properly, which reduces the amount of blood pumped out to the body. Over time, this causes blood to build up inside the left atrium, and then in the lungs, leading to fluid congestion and symptoms of heart failure.
Signs and Symptoms
Initially, signs of left-sided heart failure can go unnoticed, but they worsen over time. It is important to see a physician for regular checkups for an early diagnosis and treatment to manage signs and symptoms of heart failure. Left unchecked, this condition can cause complications including kidney and/or liver disease and heart attack.
Left-sided heart failure symptoms include:
- Awakening at night with shortness of breath
- Shortness of breath during exercise or when lying flat
- Chronic coughing or wheezing
- Difficulty concentrating
- Fluid retention causing swelling, or edema, in the ankles, legs and/or feet
- Lack of appetite and nausea
- Rapid or irregular heartbeat
- Sudden weight gain
As these symptoms occur, they cause the heart to try to pump harder, which causes further damage such as:
- Enlarged heart
- Rapid heart rate
- High blood pressure
- Less blood flowing to the arms and legs
Left-sided heart failure can be caused by underlying health problems, ranging from mild to severe. The most common cause of left-sided heart failure is caused by heart related diseases such as coronary artery disease (CAD) or a heart attack.
Other left ventricular failure causes can include:
- Cocaine use
- Heavy alcohol use
- High blood pressure
- Sleep apnea
- Tobacco use
Risk factors for left-sided heart failure can include:
- Age: Men between the ages of 50-70 often experience left-sided heart failure if they have previously suffered a heart attack.
- Aortic stenosis: When the aortic valve opening narrows, it slows blood flow and weakens the heart.
- Blood clots: A clot in the lungs can cause left-sided heart failure.
- Cardiomyopathy: Heredity can cause several types of this disease that can weaken or damage the heart.
- Congenital heart defects: Structural heart defects may prevent proper blood circulation from the heart.
- Chronic diseases: Diabetes, HIV, hyperthyroidism, hypothyroidism, or a buildup of iron or protein can lead to left-sided heart failure.
- Gender: Men are at greater risk of developing left-sided heart failure.
- Irregular heartbeats: Abnormal heart rhythms, especially if they are very frequent and fast, can weaken the heart muscle.
- Myocarditis: This condition occurs when a virus causes inflammation of the heart.
- Pericardial constriction: Inflammation causes the pericardium (a sac covering the heart) to scar, thicken and tighten the heart muscle.
- Previous heart attack: Damage to the heart muscle may affect its ability to pump blood effectively.
- Race: African-American men are at higher risk than others for developing left-sided heart failure.
- Some chemotherapy and diabetes medications: Certain drugs have been found to increase the risk of left-sided heart failure.
- Valvular heart disease: Damage or a defect in one of the four heart valves can prevent the heart from pumping blood effectively.
- Viral infection: Certain viral infections can damage the heart muscle.
To determine if a patient has left-sided heart failure, Baptist Health uses advanced technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures and technologies can include:
- Cardiac catheterization: A long, thin flexible tube is threaded through a blood vessel in the arm or groin and to the heart. Contrast material is injected through the tube and a type of X-ray video is taken to show how the heart functions and to look for heart blockages.
- Chest X-ray: A common imaging test of the lungs, heart and aorta.
- Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves.
- Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged, overworked or damaged. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.
- Electrophysiology study: This test records the heart’s electrical activities and pathways. It can help find what’s causing heart rhythm problems and identify the best treatment.
- Radionuclide imaging (thallium stress test): This non-invasive procedure can identify if there is severe heart damage. A radioactive isotope is injected into a vein and a special camera or scanner records how it travels through the heart. Any heart damage can be plotted, locating the damaged area of the heart. This procedure can be done with an electrocardiogram, during both rest and exercise.
- Treadmill Exercise Test with Peak V02: This test measures a patient’s capacity to exercise and the amount of oxygen the heart provides muscles during the test. Results reveal the severity of the left-sided heart failure and helps provide a prognosis.
Following tests, a physician will use results to classify a patient’s heart failure. The four classes are based on the ability to do normal physical activities and the symptoms caused when doing those activities.
While you cannot prevent all risk factors for left-sided heart failure, you can take steps to lower, or in some cases even reverse, your risks of diseases or conditions that can cause or complicate left-sided heart failure.
- Balance your blood sugar: If you have diabetes, watch what you eat and check your blood glucose regularly. Talk to your physician about medications that control blood sugar spikes.
- Be active: Moderate exercise helps circulation and decreases stress on your heart muscle.
- Eat a healthy diet: Limit salt, sugar, saturated fat and cholesterol; and eat plenty of fruit, vegetables, whole grains and low-fat dairy products.
- Get regular checkups: And, if you experience new or changing symptoms or side effects from medications, see your physician.
- Maintain a healthy weight: Losing weight and maintaining a healthy weight puts less stress on the heart.
- Reduce stress: Stress can contribute to a fast or irregular heartbeat.
- Reduce your alcohol intake: In some cases, you may need to stop drinking entirely. If you can drink, keep your intake low.
- Stop smoking: Smoking damages blood vessels, raises blood pressure, reduces the amount of oxygen in the blood and makes the heart beat faster.
- Take your medications as prescribed: If you’ve been prescribed medication for left-side heart failure or a causative condition, be sure to take it as prescribed.
- Weigh yourself daily: Monitor your weight for sudden gains that can indicate fluid retention.
Treatment and Recovery
Treatment for left-sided heart failure focuses on managing symptoms and treating underlying causes of the condition and mitigating risk factors for heart failure. An individualized plan of treatment may include medications, lifestyle changes, and surgery for a device implant, heart reconstruction or heart transplant. Depending on the severity of the condition, treatment for left-sided heart failure can include:
Medications can improve cardiac function, and treat symptoms of left-sided heart failure like heart rate, high blood pressure and fluid buildup, as they:
- Reduce fluid retention and the loss of potassium
- Open narrowed blood vessels to improve blood flow
- Reduce blood pressure and slow a rapid heart rhythm
- Increase blood flow throughout the body and reduce swelling
- Reduce fluid by promoting urination
- Prevent blood clots
- Lower cholesterol
A few changes in lifestyle can improve signs and symptoms and the quality of life. It is essential to follow a low-sodium, low-fat and low-cholesterol diet. Gentle aerobic exercise is also recommended.
Surgery and Other Procedures
If medications are not effective in managing left-sided heart failure, or if symptoms are severe, surgery may be necessary. Depending on the condition of the heart and underlying cause of left-sided heart failure, surgical options can include device implants, heart repair or heart transplant.
Device implant surgeries for left-sided heart failure:
- Left ventricular assist device (LVAD) surgery: This device can be implanted to help a weak heart pump more efficiently, and can be a primary treatment or a temporary measure while awaiting a heart transplant.
- Pacemaker: This device can be implanted during minor surgery to help the right and left ventricle contract normally.
- Heart repair or transplant surgeries for left-sided heart failure:
- Congenital heart defect repair surgery: Repairing a heart defect can improve blood flow.
- Coronary artery bypass graft (CABG): This surgery creates a bypass around your narrowed coronary arteries by grafting arteries or veins taken from other parts of your body, which improves blood flow, stops chest pain and prevents a heart attack.
- Heart reconstruction surgery: Electric signals travel through a healthy heart, shaped like a football, causing it to contract. But heart damage enlarges and stretches the heart to be shaped more like a basketball, affecting electrical signals that make the heart pump less efficiently. Reconstructing the shape of the heart can improve its electrical signaling and functioning. Types of reconstruction include:
Artificial heart valve surgery: Repair or replacement of a valve can reduce an enlarged heart and increase heart function.
Dynamic cardiomyoplasty: A muscle from a patient’s back is detached and wound around the heart’s ventricles. The relocated muscle is programmed to beat like the heart’s muscle, which improves heart function and reduces stress on the heart.
The Dor procedure: Stitching a widened artery (an aneurysm) of scarred tissue, caused by a previous heart attack, can shrink the dead area of the heart and help it regain a more shape.
The Acorn procedure: A mesh-like sock placed over the heart is stitched into place to prevent the heart from enlarging.
- Heart transplant surgery: This surgery is done when all other left-sided heart failure treatments have failed. The damaged heart is surgically removed and replaced with a healthy heart from a deceased donor.
The prognosis for left-sided heart failure varies, depending on the cause of the condition and severity of the symptoms. Some will improve with treatment and lifestyle changes. For others, left-sided heart failure can be life-threatening. Severe symptoms can require a device to be implanted, heart repair or a heart transplant, to prevent further heart damage and complications, including kidney and/or liver failure and a heart attack.
Left-sided heart failure complications can include:
- Angina: Chest, jaw, neck discomfort or pressure is caused by the lack of blood flowing to the heart.
- Atrial fibrillation: This irregular heart rhythm can increase the risk of stroke and blood clots.
- Cardiac cachexia: This unintentional weight loss of at least 7.5 percent of normal weight within six months can be life-threatening without supplemental nutrition.
- Heart valve issues: Increased pressure on the heart can disrupt blood from flowing in the right direction throughout the heart.
- Heart attack: The heart muscle is damaged permanently by the lack of blood flow to the heart for an extended period of time.
- Impaired kidney function: Decreased kidney function is common in patients with left-sided heart failure. If the kidneys receive less blood, kidney failure can occur, requiring dialysis treatment.
- Liver damage: Fluid backing up from the heart puts pressure on the liver that can cause scarring, which makes it harder for the liver to function properly.
- Right-sided heart failure: As a result of left-sided heart failure, blood flows back through the lungs, weakening the right side of the heart. This can cause fluid to build up in the lungs and cause swelling in the legs and ankles, and lead to GI and liver damage.
At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. We work to demonstrate the utmost in excellent care to those who trust us with their health.
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