Left-sided heart failure

Overview

Left-sided heart failure is a type of heart failure that affects the lower left heart chamber, called the left ventricle. That chamber is the heart's main pumping chamber. In this condition, the chamber cannot pump blood well or cannot fill as it should between heartbeats. When the chamber doesn't work well, pressure can build up behind the left side of the heart and in the lungs.

Some heart conditions slowly leave the heart too weak or stiff to fill and pump blood properly. These conditions include narrowed arteries in the heart and high blood pressure.

Treatment may improve the symptoms of left-sided heart failure and may help some people live longer. Lifestyle changes can improve quality of life. Try to manage your weight, exercise, use less salt and manage stress.

But left-sided heart failure can be life-threatening. It can cause serious symptoms. Some people with left-sided heart failure may need a heart transplant or a device to help the heart pump blood.

Left-sided heart failure is sometimes called left-sided congestive heart failure when it causes fluid buildup known as congestion. Not all left-sided heart failure is congestive heart failure.

Types

In left-sided heart failure, the left ventricle has either trouble pumping blood out or has trouble filling with enough blood between heartbeats. Either type can cause symptoms of left-sided heart failure and may need different treatments.

• Heart failure with reduced ejection fraction (HFrEF), also called systolic heart failure. The left ventricle does not squeeze as hard as it should. The heart isn't strong enough to pump enough blood to the body.
• Heart failure with preserved ejection fraction (HFpEF), also called diastolic heart failure. The left ventricle may squeeze well but be too stiff to fill enough between heartbeats.
• Heart failure with improved ejection fraction (HFimpEF), formerly called heart failure with recovered ejection fraction (HFrecEF). In this subtype of left-sided heart failure, the ejection fraction was reduced in the past but has improved. This means a low ejection fraction is not always permanent. But heart failure can come back, so treatment usually needs to continue.

Left-sided heart failure differs from right-sided heart failure, which affects how the heart pumps blood to the lungs. Over time, left-sided heart failure can lead to right-sided heart failure.

Symptoms

Symptoms of left-sided heart failure can come on slowly or suddenly. They may include:

• Shortness of breath during activity or when lying down.
• Tiredness and weakness.
• Swelling in the feet, ankles or legs. This is more likely if heart failure affects both sides of the heart.
• A fast heartbeat or one that isn't regular.
• Less ability to exercise or do usual activities.
• A cough or wheezing that doesn't go away.
• Quick weight gain due to fluid buildup.

When to see a doctor

See your healthcare professional if you get new symptoms that could be linked to heart failure.

Call your healthcare professional right away if you have heart failure and:

• Your symptoms suddenly get worse.
• You have a new symptom.
• You gain 5 pounds (2.3 kilograms) or more within a few days.

Such changes could mean that existing heart failure is getting worse or that treatment isn't working.

When to seek emergency care

A sudden buildup of fluid in the lungs is called pulmonary edema. Pulmonary edema is a medical emergency. Call 911 or emergency medical help if you have sudden, serious shortness of breath and are coughing up white or pink foamy mucus.

Causes

A condition that damages the left ventricle or makes it work harder over time can cause left-sided heart failure. Common causes include:

• Coronary artery disease. Narrowed heart arteries can reduce blood flow to the heart muscle and weaken its pumping ability.
• Heart attack. A heart attack can damage part of the left ventricle and make it harder for the heart to pump blood.
• High blood pressure, also called hypertension. Over time, the left ventricle may thicken or stiffen as it works harder to pump blood against higher pressure.
• Heart valve disease. The valves of the heart keep blood flowing the right way. A narrowed or leaky heart valve can make the left ventricle work harder. This can weaken the heart over time.
• Cardiomyopathy. Diseases of the heart muscle can weaken the heart or make the left ventricle stiff.
• Heart arrhythmias. Heart rhythms that are too fast, too slow or not regular can keep the heart from pumping well.
• Myocarditis. Swelling and irritation of the heart muscle can damage the left ventricle. A virus is most often the cause of myocarditis. This includes the virus that causes COVID-19.
• Congenital heart disease. Heart conditions you're born with can sometimes lead to heart failure later in life.

Certain medicines, some cancer treatments, heavy use of alcohol and use of other substances that are toxic to the heart also can damage the heart muscle and lead to left-sided heart failure.

Risk factors

Besides being older or having obesity, the following may increase your risk of getting heart failure:

• Diabetes.
• Smoking.
• Not being active.
• Sleep apnea.
• Kidney disease.
• Family history of cardiomyopathy or heart failure.
• Heavy alcohol use.

Many risk factors also raise your risk of getting coronary artery disease, high blood pressure or other conditions that can lead to heart failure.

Complications

Left-sided heart failure can get worse over time and lead to other health conditions. Possible complications include:

• Pulmonary edema. Increased pressure in the blood vessels of the lungs can cause fluid to collect in lung tissue, making it hard to breathe.
• Pulmonary hypertension. Ongoing pressure buildup on the left side of the heart can increase pressure in the blood vessels that carry blood through the lungs.
• Right-sided heart failure. Increased pressure in the lungs can make the right side of the heart work harder. Over time, the right ventricle may weaken.
• Kidney damage or failure. Less blood flow and fluid buildup can affect how well the kidneys work.
• Heart rhythm issues. Changes in the heart muscle can raise the risk of heartbeats that are too fast, too slow or not regular.

Prevention

You can't always prevent left-sided heart failure. But managing conditions that damage the heart can lower the risk.

What you can do:

• Manage high blood pressure.
• Manage diabetes and cholesterol levels.
• Don't use tobacco.
• Get to and stay at a healthy weight.
• Get regular physical activity.
• Limit alcohol or don't drink.