Left-Sided Heart Failure

What is left-sided heart failure?

This condition occurs when the left side of the heart no longer functions appropriately. There are two types:

• Systolic heart failure: The bottom pumping chamber of your heart called the left ventricle is too weak to pump blood out to your body. It’s also known as heart failure with reduced ejection fraction.
• Diastolic heart failure: The left ventricle is stiff and can’t relax appropriately, making it difficult to fill with blood. This condition is also known as heart failure with preserved ejection fraction.

What do the left and right sides of the heart do?

The two sides of your heart work in different ways to pump blood.

• Left side: Receives oxygen-rich blood from your lungs and delivers it to the rest of your body. The oxygen helps organs, muscles and other tissue do their job.
• Right side: Receives oxygen-poor blood from your body and delivers it to your lungs. From there, you release carbon dioxide and take in more oxygen.

What causes left-sided heart failure?

Left-sided heart failure may occur in people with:

• Coronary artery disease.
• Heart attack.
• High blood pressure.
• Valvular heart disease.
• Abnormal heart rhythms.
• Infiltrative diseases such as amyloid and sarcoid.

Other risk factors for left-sided heart failure include:

• Certain chemotherapy treatments for cancer that cause cardiotoxicity.
• Diabetes.
• Obesity.
• Sleep apnea.
• Older age.
• Smoking.
• Toxins to your heart such as certain drugs and energy drinks.
• Less commonly, certain medications that are used to treat different disease processes, like autoimmune diseases and attention-deficit/hyperactivity disorder.

What are the symptoms of left-sided heart failure?

Symptoms may be mild at first or you may think it's a cold or allergy. You might not even notice them. But as heart function worsens, you may experience:

• Constant coughing.
• Shortness of breath with walking or bending over.
• Waking up short of breath or unable to lie flat at night.
• Weight gain.
• Swelling (edema) in your ankles, legs or abdomen.

Over time, the heart works harder to do its job. This causes complications that may include:

• Cardiogenic shock.
• Enlarged heart.
• Abnormal heart rates and rhythms (arrhythmia).

How is left-sided heart failure diagnosed?

Healthcare providers diagnose by obtaining a thorough history and performing a physical examination along with ordering laboratory tests and imaging studies.

Laboratory tests

Lab tests for left-sided heart failure use a sample of blood. They detect signs of heart disease and rule out other causes of your symptoms. You may need:

• BNP (biomarker) blood test to check for hormones that occur with pressure changes inside the heart.
• Metabolic panel to check your kidney and liver function along with electrolytes such as sodium and potassium.

Imaging studies

Heart imaging tests you may need include:

• Electrocardiogram (EKG) to record and assess the heart’s electrical activity.
• Echocardiogram (ECHO) to show heart movement and blood flow.
• Coronary angiography to examine the heart’s blood vessels.
• Cardiac MRI to get a high-definition view of the heart.

What does left-sided heart failure treatment involve?

There are many treatment options. The ones that are right for you depend on whether the issue is diastolic heart failure or systolic heart failure.

Treatment often includes medications to improve heart functioning:

• ACE inhibitors/Angiotensin II receptor blockers (ARBs)/ Angiotensin-receptor neprilysin inhibitors (ARNIs) relax blood vessels and help remodel the heart.
• Aldosterone antagonists control stress hormones to prevent symptoms from worsening also act as a mild water pill.
• Beta blockers decrease your heart rate and how hard the heart has to work.
• Digoxin can help people feel better and help control heart rate.
• Water pills (diuretics) help your body get rid of excess fluid.
• Sodium-glucose transport protein 2 (SGLT2) inhibitors work in people with or without diabetes to help decrease excess fluid.

Will I need a procedure as part of my left-sided heart failure treatment?

A procedure may be necessary if:

• Your symptoms don’t improve.
• Your testing or labs show signs of worsening heart failure.

Your care may include:

• Cardiac resynchronization therapy (CRT): An implantable device that uses a gentle electrical current to stimulate your heart’s pumping action. It’s also called a biventricular pacemaker.
• Electrical cardioversion: This procedure helps restore a normal rhythm.
• Implantable cardioverter defibrillator (ICD): This implantable device detects arrhythmias and sends a gentle electrical current to restore a normal rhythm.
• Left ventricular assist device (LVAD): An implantable pump that helps the heart circulate blood.
• Heart transplant: Procedure to replace a worn-out heart with a healthy one from a donor. This treatment is for patients with the most severe forms of left-sided heart failure.

How can I prevent left-sided heart failure?

Living a heart-healthy lifestyle can lower your risk of left-sided heart failure. If you’ve already experienced this condition, healthy habits can help you avoid future issues.

Steps you can take to prevent left-sided heart failure include:

• Manage your blood pressure or coronary artery disease.
• Make time for regular physical activity and a good night’s sleep.
• Maintain a healthy weight and eat fruits and vegetables.
• Manage stress with deep breathing or relaxation techniques.
• Quitting tobacco if you use it and avoiding secondhand smoke.

What is the outlook for people with left-sided heart failure?

Your outlook can be excellent as long you keep routine appointments with your care team and take medications as recommended by your provider.

What are the complications of left-sided heart failure?

Complications of left-sided heart failure can include:

• Arrhythmias or abnormal heart rhythms such as ventricular tachycardia and atrial fibrillation (Afib).
• Obstructive and central sleep apnea.
• Heart valve disease (leaky valves).
• Liver disease.
• Right-sided heart failure.
• Frailty and muscle weakness.
• Anemia.
• Kidney disease.
• Depression or anxiety.

How will my life be different with left-sided heart failure?

Life after left-sided heart failure often includes changes such as:

• Becoming more physically active.
• Checking your blood pressure every day.
• Continuing heart failure medications.
• Going to regular follow-up appointments so healthcare providers can monitor your progress.
• Lowering your salt intake.
• Weighing yourself daily to check for sudden weight gain.

A note from Cleveland Clinic

Left-sided heart failure occurs when the heart loses its ability to pump blood. It often happens in people with high blood pressure and certain heart conditions. You may experience systolic heart failure or diastolic heart failure. Treatment can boost your heart’s pumping ability. Left-sided heart failure symptoms can come back. Ongoing therapies and lifestyle changes can lower this risk.