Left Ventricular Dysfunction

Left ventricular dysfunction occurs when the heart’s main pumping chamber loses its ability to effectively send oxygen-rich blood throughout the body, leading to symptoms that can significantly impact daily life and overall health.

Table of contents

• What is Left Ventricular Dysfunction?
• How the Heart Works
• Types of Left Ventricular Dysfunction
• Causes and Risk Factors
• Symptoms
• Complications
• Diagnosis
• Treatment
• Living With Left Ventricular Dysfunction
• Prevention

What is Left Ventricular Dysfunction?

Left ventricular dysfunction happens when the left side of the heart no longer functions properly. The left ventricle is the heart’s main pumping chamber, responsible for sending oxygen-rich blood to all parts of the body. When this chamber fails to work effectively, it cannot deliver enough blood to vital organs, which can significantly affect your overall health and quality of life.^[1]

This condition is also called left-sided heart failure or left heart failure. When the left ventricle’s function is impaired but the patient does not show clear symptoms, it is referred to as asymptomatic left ventricular dysfunction. However, when symptoms appear, it becomes systolic heart failure or heart failure with reduced ejection fraction (HFrEF).^[3]

• Left ventricle
• Heart

How the Heart Works

Understanding how the heart works helps explain what happens when left ventricular dysfunction develops. The heart has two sides that work in different ways to pump blood throughout the body.^[1]

The 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 tissues do their job. The right side receives oxygen-poor blood from your body and delivers it to your lungs, where you release carbon dioxide and take in more oxygen.^[1]

Types of Left Ventricular Dysfunction

Left ventricular dysfunction can be divided into different types based on how the heart muscle is affected.^[1]

Systolic heart failure occurs when the bottom pumping chamber of your heart, called the left ventricle, is too weak to pump blood out to your body. This is also known as heart failure with reduced ejection fraction. In this type, the left ventricle fails to contract normally, which doctors call “pump failure.”^[1][5]

Diastolic heart failure happens when the left ventricle becomes stiff and cannot relax properly, making it difficult to fill with blood. This condition is also known as heart failure with preserved ejection fraction.^[1]

Left ventricular failure can be further classified based on ejection fraction, which is the percentage of blood pumped out of the heart with each beat. Heart failure with reduced ejection fraction means the ejection fraction is less than 40 percent. Heart failure with preserved ejection fraction means the ejection fraction is over 50 percent. There is also a category called heart failure with mid-range ejection fraction, where the ejection fraction is between 41 and 49 percent.^[2]

The severity of left ventricular systolic dysfunction can range from asymptomatic (no symptoms), to moderate (noticeable decrease in pumping ability with symptoms during moderate activity), to severe (significant impairment leading to symptoms even at rest).^[3]

Causes and Risk Factors

The most common causes of left ventricular dysfunction are coronary artery disease and high blood pressure. High blood pressure can cause left ventricular dysfunction in two ways: it can lead to left ventricular hypertrophy (thickening of the heart muscle), which results in heart failure with preserved ejection fraction, and it also serves as a risk factor for coronary artery disease, which can lead to heart failure with reduced ejection fraction.^[2]

Multiple conditions and factors can lead to left heart failure. These include:^[1]

• 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 developing left-sided heart failure include:^[1][2]

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

Chronic or poorly controlled hypertension causes increased workload on the heart, which can lead to hypertrophy of the left ventricle. Initially, this thickening serves as a compensatory mechanism and can help maintain heart function, but over time it can prevent the heart muscle from relaxing properly, leading to impaired filling and decreased output. Coronary arterial disease causes direct damage to the heart muscle from lack of oxygen, leading to changes in the heart’s structure.^[2]

Many of these causes are preventable, which is why controlling risk factors remains extremely important in preventing heart failure.^[2]

Symptoms

Symptoms may be mild at first, or you may think you have a cold or allergy. You might not even notice them initially. However, as heart function worsens, you may experience:^[1][5]

• 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
• Weakness and tiredness that persists after rest
• Rapid or irregular heartbeat
• Decreased mental focus and confusion
• Loss of appetite with nausea
• Sudden weight increase without explanation

These symptoms result from the heart’s reduced pumping ability, leading to fluid retention and decreased oxygen delivery to tissues. Recognizing these signs early is essential for timely diagnosis and intervention.^[3]

Complications

Over time, the heart works harder to do its job when it has left ventricular dysfunction. This causes complications that may include:^[1]

• Cardiogenic shock
• Enlarged heart
• Abnormal heart rates and rhythms (arrhythmia)
• Right-sided heart failure
• Organ damage

Left ventricular dysfunction is a serious condition that can lead to significant health complications if left untreated. It increases the risk of heart failure, arrhythmias, and sudden cardiac death. Early diagnosis and management are essential to improve outcomes and quality of life for affected individuals.^[3]

Diagnosis

Healthcare providers diagnose left ventricular dysfunction by obtaining a thorough medical history and performing a physical examination, along with ordering laboratory tests and imaging studies.^[1]

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:^[1]

• 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:^[1][5]

• 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

Specialists perform an echocardiogram to check the ejection fraction, which is a key measurement in diagnosing the type and severity of left ventricular dysfunction.^[5]

Treatment

There are many treatment options for left ventricular dysfunction. The ones that are right for you depend on whether the issue is diastolic heart failure or systolic heart failure. Heart failure has no cure, but treatment can help you live a longer, more active life with fewer symptoms.^[1]

Medications

Treatment often includes medications to improve heart functioning:^[1][8]

ACE inhibitors, Angiotensin II receptor blockers (ARBs), and Angiotensin-receptor neprilysin inhibitors (ARNIs) relax blood vessels and help the heart work more efficiently. ACE inhibitors work by relaxing and opening up your blood vessels, which makes it easier for your heart to pump blood around the body. Examples include ramipril, captopril, enalapril, lisinopril and perindopril. The most common side effect is a dry, irritating cough.^[8]

Beta blockers work by slowing your heart down and protecting your heart from the effects of adrenaline and noradrenaline, “fight or flight” chemicals produced by the body. The main ones used to treat heart failure are bisoprolol, carvedilol and nebivolol. Possible side effects include dizziness, tiredness and blurred vision.^[8]

Mineralocorticoid receptor antagonists (MRAs) make you pass more urine and help lower blood pressure and reduce fluid around the heart. The most widely used MRAs are spironolactone and eplerenone.^[8]

Diuretics (water pills) make you pass more urine and help relieve ankle swelling and breathlessness caused by heart failure. The most widely used for heart failure are furosemide and bumetanide.^[8]

SGLT2 inhibitors are a newer class of medications that have shown benefit in treating heart failure.^[8]

Other medications may include ivabradine, sacubitril valsartan, hydralazine with nitrate, and digoxin, depending on your specific condition.^[8]

Devices and Surgery

Some patients may benefit from devices implanted in the chest to control heart rhythm or surgical procedures, depending on the severity and cause of their condition.^[8]

Living With Left Ventricular Dysfunction

By making lifestyle changes, you can take an active role in treating your heart failure while maintaining a productive life. Living well with heart failure is absolutely possible, and you are in the driver’s seat.^[18]

Lifestyle Changes

You can take charge of your health by:^[18]

• Taking your medications as prescribed
• Being active
• Eating foods low in salt
• Keeping track of your symptoms and moods
• Following your treatment plan
• Scheduling regular follow-up visits
• Staying in touch with your heart care team

Diet and Nutrition

When you have heart failure, it’s important to control how much salt, or sodium, you get each day. Too much salt can make your body act like a sponge, holding water that causes your legs to swell and fluid to collect in your lungs. This makes your heart work harder.^[18]

Aim to consume no more than a teaspoon of salt a day, including from packaged foods and salt you add when cooking. Read food labels and choose foods with less than 140 mg of sodium per serving. Watch for salt sneaking into your diet from common foods like bread, soup, salad dressing and cheese, as well as cold cuts, takeout, frozen dinners and fast food.^[18]

A healthy, balanced diet should include plenty of fruit and vegetables (at least 5 portions a day), meals based on starchy foods, some dairy or dairy alternatives, some beans or pulses, fish, eggs, meat and other sources of protein, and low levels of saturated fat, salt and sugar.^[14]

Physical Activity

Regular physical activity can help improve your symptoms and general health. If you have heart failure, you should be offered an exercise-based cardiac rehabilitation programme. Before you start, you’ll have an assessment to find out how much exercise you can safely do. A programme of exercise can then be tailored specifically for you.^[14]

It’s important to stay as active as possible. Increase your activities slowly, and always listen to your body so you know when it’s time to take a rest break.^[19]

Monitoring Your Condition

You may be asked to help monitor your condition between appointments. Your care team may suggest weighing yourself regularly so any changes in your weight, which could be a sign of a problem, are picked up quickly.^[14]

Know what signs to watch for and tell your care team about them. These can be an early warning that your heart failure may be getting worse. For example: rapid weight gain, swelling (especially in the legs and ankles), noticing that you feel more short of breath or tired, coughing, and needing to sleep with extra pillows.^[16]

Other Important Considerations

If you smoke, stopping can improve your overall health and reduce your risk of many other health problems. You can usually continue to drink alcohol if you have heart failure, but it’s advisable not to exceed the recommended limits of more than 14 alcohol units a week.^[14]

Everyone with heart failure should be offered the annual flu vaccine and the one-off pneumococcal vaccination. You can get these vaccinations at your GP surgery or a local pharmacy that offers a vaccination service.^[14]

Having heart failure shouldn’t prevent you from travelling or going on holiday, as long as you feel well enough and your condition is well controlled. However, check with your doctor before you travel.^[14]

Prevention

Many causes of left ventricular dysfunction are preventable. Risk factor control remains of extreme importance in preventing heart failure.^[2]

Key prevention strategies include:^[1][5]

• Controlling high blood pressure
• Managing diabetes
• Maintaining a healthy weight
• Not smoking
• Staying physically active
• Eating a healthy diet low in salt and saturated fat
• Limiting alcohol consumption
• Getting regular check-ups to monitor your heart health

Early preventive treatment of left ventricular dysfunction following a heart attack, with optimal timing and patient selection, can help prevent the condition from worsening and possibly reduce the occurrence of heart failure.^[10]