Left-sided heart failure

Diagnosis

To diagnose left-sided heart failure, a healthcare professional asks about symptoms and medical history and does a physical exam. The exam may include listening to the heart and lungs and checking for signs of fluid buildup, such as swelling in the legs or feet.

During an exam, a healthcare professional may hear popping or cracking sounds when listening to the lungs through an instrument called a stethoscope. Fluid buildup in the lungs can cause these sounds, called crackles.

Tests

Tests are done to check your heart and find causes of your symptoms. Tests to help diagnose left-sided heart failure may include:

• Blood tests. Blood tests can look for conditions that may cause heart failure or make it worse.
• Electrocardiogram (ECG or EKG). This test records the heart's electrical activity. It can find issues with heart rhythm and electrical signals.
• Chest X-rays. An X-ray can show whether the heart is larger than usual and whether fluid has built up in the lungs.
• Echocardiogram. Sound waves make pictures of the heart. This test can show how well the left ventricle pumps and fills, measure ejection fraction, and check the heart valves.
• Cardiac MRI. This test uses magnetic fields and radio waves to make detailed pictures of the heart.

Treatment

Treatment for left-sided heart failure depends on its cause, how well the left ventricle pumps, your symptoms and your other health conditions. Treatment aims to ease symptoms, reduce fluid buildup, slow the advance of heart failure, prevent hospital stays and help you live longer.

Treatment often includes lifestyle changes and medicines. If caught early, left-sided heart failure may get better with treatment for the condition that causes it.

Medicines

Several types of medicines may be used. The mix depends in part on the type of heart failure.

For left-sided heart failure with reduced ejection fraction, medicines may include:

• Angiotensin-converting enzyme (ACE) inhibitors. These medicines help relax blood vessels, improve blood flow and ease strain on the heart. Examples include enalapril (Vasotec, Epaned), lisinopril (Zestril, Qbrelis) and captopril.
• Angiotensin 2 receptor blockers (ARBs). These medicines have many of the same benefits as ACE inhibitors. They may be an option for people who can't tolerate ACE inhibitors. They include losartan (Cozaar), valsartan (Diovan) and candesartan (Aasand).
• Angiotensin receptor plus neprilysin inhibitors (ARNIs). This treatment combines the medicines sacubitril and valsartan (Entresto). It's used to treat some people who have heart failure with reduced ejection fraction. It may help prevent the need for a hospital stay in those people.
• Beta blockers. These medicines slow the heart rate and lower blood pressure. They ease the symptoms of left-sided heart failure and help the heart work better. Examples include carvedilol (Coreg), metoprolol (Lopressor, Toprol-XL, Kapspargo Sprinkle) and bisoprolol.
• Mineralocorticoid receptor antagonists. These medicines can help ease fluid retention and the effects of hormones that can worsen heart failure.
• Diuretics. Often called water pills, these medicines make you urinate more often. This helps prevent fluid buildup in the body. Diuretics, such as furosemide (Lasix, Furoscix), also lessen fluid in the lungs, so it's easier to breathe.

  Some diuretics make the body lose potassium and magnesium. Your healthcare professional may advise you to take supplements to treat this. If you take a diuretic, you may have regular blood tests to check your potassium and magnesium levels.

• Sodium-glucose cotransporter-2 (SGLT2) inhibitors. These medicines can lower blood sugar. They are often prescribed with diet and exercise to treat type 2 diabetes. But they're also one of the first treatments for heart failure. Several studies have shown that the medicines lower the risk of hospital stays and death in people with certain types of heart failure — even if they don't have diabetes. These medicines include canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance).

Your healthcare professional may need to change your medicine doses often. This is more common when you've just started a new medicine or when your condition is getting worse.

Surgery or other procedures

Some people may need surgery or a heart device to treat left-sided heart failure. Treatments may include:

• Coronary artery bypass graft surgery. You may need this surgery if blocked arteries are causing your heart failure. The surgery involves taking a healthy blood vessel from the leg, arm or chest to make a new route for blood to flow around the blocked artery. The new pathway improves blood flow to the heart muscle.
• Heart valve repair or replacement. If a damaged heart valve causes heart failure, your health professional may advise repairing or replacing the valve. The type of heart surgery you need depends on the cause of the heart valve disease.

  Heart valve repair or replacement may be done as open-heart or minimally invasive surgery.

• Implantable cardioverter-defibrillator (ICD). An ICD is used to prevent complications of heart failure. It doesn't treat heart failure itself. An ICD is a device like a pacemaker. It's implanted under the skin in the chest with wires leading through the veins and into the heart.

  The ICD checks the heartbeat. If the heart starts beating at a dangerous rhythm, the ICD tries to correct the beat. An ICD also can work as a pacemaker and speed up a slow heartbeat.

• Left ventricular assist device (LVAD). An LVAD helps pump blood from the left ventricle of the heart to the rest of the body. It's also called a mechanical circulatory support device. Your healthcare professional may advise you to get an LVAD if you're waiting for a heart transplant. Or it may be treatment for left-sided heart failure for people who can't have a heart transplant.
• Cardiac resynchronization therapy (CRT). Also called biventricular pacing, CRT is a treatment for heart failure in people whose lower heart chambers aren't pumping in sync with each other. A device sends electrical signals to the lower heart chambers. The signals tell the chambers to work together. This improves the pumping of blood out of the heart. CRT may be used with an ICD.
• Heart transplant. Some people have heart failure that surgery or medicines don't help. These people may need to have their hearts replaced with donor hearts.

  A heart transplant isn't right for everyone. A team of healthcare professionals at a transplant center helps decide whether the procedure may be a safe choice that helps you.

Symptom care and end-of-life care

Your healthcare team may suggest special medical care to ease symptoms and improve quality of life. This is called palliative care. This type of care is for anyone who has a serious or life-threatening illness. It can treat symptoms or ease side effects of treatment.

In some people with heart failure, medicines no longer work and a heart transplant or device isn't an option. Then the healthcare team may advise special end-of-life care. This is called hospice care.

Hospice care allows people who care about you to help care for and comfort you with the aid of nurses, social workers and trained volunteers. You can get hospice care in your home or in a nursing home or assisted living center.

Hospice care provides the following to you and those who care for you:

• Emotional support.
• Psychological support.
• Spiritual support.

Although it can be hard, discussing end-of-life issues with people who care for you and your medical team is important. This may involve an advance care directive. This is a general term for spoken and written instructions you give about your medical care if you can't speak for yourself.

If you have an ICD, also discuss whether and when to turn off the device so that it can't give shocks near the end of life.

Self-care

Some people with heart failure may be told to take omega-3 fatty acid supplements. Some research shows that the supplements may help reduce the need for hospital stays.

Making certain lifestyle changes often improves heart failure symptoms. It may even slow the condition from getting worse.

The following changes are recommended to improve heart health:

• Don't smoke. Smoking damages blood vessels and raises blood pressure. It lowers blood oxygen levels and speeds up the heartbeat. Quitting is the best thing you can do to help your heart health. If you need help quitting, talk with your health professional. You can't have a heart transplant if you smoke. Also stay away from other people's smoke.
• Check your legs, ankles and feet for swelling. Do this every day. Call your healthcare professional if the swelling gets worse.
• Weigh yourself. Ask your healthcare professional how often you should do this. Weight gain may mean your body is holding onto fluid. You may need a change in treatment. Call your health professional if you gain 5 pounds (2.3 kilograms) or more within a few days.
• Manage weight. Being overweight increases the risk of heart disease. Ask your health professional what weight is best for you. Even losing a small amount of weight can help improve heart health.
• Eat a healthy diet. Aim to eat a diet that includes fruits and vegetables, whole grains, fat-free or low-fat dairy products, and lean proteins. Limit saturated and trans fats.

• Ask about salt. Too much salt, also called sodium, can make the body hold onto water. This is called water retention. It makes the heart work harder. Symptoms include shortness of breath and swollen legs, ankles and feet.

  Ask your health professional whether you should follow a no-salt or low-salt diet. Keep in mind that salt has been added to many prepared foods. Read labels.

• Ask how much fluid you can have. If you have serious heart failure, your health professional may suggest that you limit the amount of fluid you drink.
• Limit or don't drink alcohol. Alcohol can interfere with certain medicines. It also weakens the heart and raises the risk of heartbeats that aren't regular. If you have heart failure, your health professional may advise you not to drink any alcohol.
• Stay as active as you can. Moderate exercise helps keep the heart and body healthy. But be sure to talk with your health professional about an exercise program that's right for you. If you have heart failure, your health professional may suggest a walking program or a cardiac rehabilitation program at your local hospital.
• Lower stress. Strong feelings such as worry or anger can make the heart beat faster. Breathing becomes heavier and blood pressure goes up. These changes can make heart failure worse.

  Find ways to lower stress. Practicing mindfulness and connecting with others in support groups are some ways to lower and manage stress.

• Get better sleep. Heart failure can cause shortness of breath, especially when lying down. Try sleeping with your head propped up using a pillow or a wedge. If you snore or have had other sleep issues, get tested for sleep apnea.
• Get recommended vaccinations. Ask your health professional about getting influenza, pneumonia and COVID-19 vaccinations.

Coping and support

Managing heart failure requires open communication between you and your health professional. Be honest about any challenges with your diet, lifestyle and medicine use. Notice how you feel. Tell your health professional when you feel better or worse. This helps guide your treatment.

Preparing for your appointment

If you worry about your heart failure risk, make an appointment with your healthcare professional. You may be sent to a doctor trained in heart diseases, called a cardiologist. Finding heart failure early may make treatment easier and work better.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do before you go. This may include fasting before certain tests. If possible, take someone with you to the appointment to help you remember what you learn.

Make a list of:

• Your symptoms and when they began. Include any that may not seem related to heart failure.
• Key personal information, including a family history of heart disease, stroke, high blood pressure or diabetes, and major stresses or recent life changes. Find out if anyone in your family has had heart failure.
• All medicines, vitamins and supplements you take. Include doses. Take the list with you to all health checkups.

For heart failure, questions may include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my symptoms?
• What tests do I need? How do I prepare for the tests?
• What treatments are there? Which do you suggest for me?
• How often should I be screened for changes in my condition?
• I have other health conditions. How can I best manage these conditions together?
• When is it safe for my partner and me to have sex?

Be sure to ask all the questions you have.

What to expect from your doctor

Your health professional is likely to ask many questions, such as:

• Do you have symptoms all the time, or do they come and go?
• How bad are your symptoms?
• What, if anything, seems to make your symptoms better?
• Does anything make your symptoms worse?

What you can do in the meantime

It's never too early to make healthy-lifestyle changes, such as quitting smoking, cutting down on salt and eating healthy foods. These changes can help prevent heart failure or keep it from getting worse.