Left Ventricular Failure

Left ventricular failure happens when the heart’s main pumping chamber can’t deliver enough blood to the body’s vital organs, causing symptoms that can significantly affect daily life and require ongoing medical care.

Table of contents

• What Is Left Ventricular Failure?
• Types of Left Ventricular Failure
• What Causes Left Ventricular Failure?
• Risk Factors and Who Is Affected
• Signs and Symptoms
• How Is It Diagnosed?
• Treatment Options
• Lifestyle Changes and Self-Care
• Living With Left Ventricular Failure

What Is Left Ventricular Failure?

The heart is made up of three main layers: the outer protective covering called the pericardium, the middle muscular layer known as the myocardium, and the inner lining called the endocardium. When any of these structures becomes damaged, it can lead to heart problems^[1].

Left ventricular failure occurs when the left ventricle, which is the main pumping chamber on the left side of your heart, stops working properly. This means it cannot pump enough blood to supply your body’s vital organs with the oxygen and nutrients they need^[1][2].

The two sides of your heart work differently to move blood through your body. The left side receives oxygen-rich blood from your lungs and pumps it out to the rest of your body, delivering oxygen that helps your organs, muscles, and other tissues do their work. The right side receives oxygen-poor blood from your body and sends it to your lungs, where you release carbon dioxide and take in fresh oxygen^[2].

Types of Left Ventricular Failure

Left ventricular failure can be divided into different types based on a measurement called ejection fraction, which is the percentage of blood that leaves your heart each time it contracts^[1][2]:

Heart failure with reduced ejection fraction (HFrEF) occurs when the left ventricle becomes too weak to pump blood effectively. This is also called systolic heart failure. In this type, the ejection fraction is less than 40 percent^[1][2].

Heart failure with preserved ejection fraction (HFpEF) happens when the left ventricle becomes stiff and cannot relax properly, making it difficult to fill with blood. This is also known as diastolic heart failure. The ejection fraction is over 50 percent^[1][2].

Heart failure with mid-range ejection fraction falls between the other two types, with an ejection fraction between 41 and 49 percent^[1].

What Causes Left Ventricular Failure?

The most common causes of left ventricular failure are coronary artery disease and high blood pressure^[1][2].

High blood pressure can lead to left heart failure in two ways. First, it causes increased strain on the heart, which can make the left ventricle grow thicker over time. This thickening, called left ventricular hypertrophy, initially helps the heart maintain its pumping ability. However, over the long term, this thickening prevents the heart muscle from relaxing properly, which impairs the heart’s ability to fill with blood and reduces how much blood it can pump out^[1].

Coronary artery disease causes direct damage to the heart muscle by reducing blood flow and oxygen supply to the heart tissue. This damage, called ischemic damage, can weaken the heart’s pumping ability^[1].

Other conditions that can lead to left ventricular failure include^[2][3]:

• Heart attack
• Heart valve disease
• Abnormal heart rhythms
• Diseases that affect the heart muscle, such as amyloid and sarcoid
• Birth defects affecting the heart

Risk Factors and Who Is Affected

Heart failure is more common in older people. Approximately 5.7 million people in the United States have been diagnosed with heart failure. The rate of new cases is around 10 per 1,000 people in those over 65 years old^[1].

About 50 percent of all patients with heart failure have heart failure with reduced ejection fraction, and this type is becoming more common over time. Heart failure with preserved ejection fraction is more common in women (79 percent versus 49 percent) and tends to affect an older population^[1].

Several factors can increase your risk of developing left ventricular failure^[1][2]:

• Diabetes
• Smoking
• Obesity
• Being male
• Living a sedentary lifestyle (not being physically active)
• Sleep apnea
• Older age
• Certain chemotherapy treatments for cancer that can damage the heart
• Exposure to toxins such as certain drugs and energy drinks
• Less commonly, certain medications used to treat autoimmune diseases and attention-deficit/hyperactivity disorder

Many of these risk factors can be prevented or controlled, which is why managing them is extremely important in preventing heart failure^[1].

Signs and Symptoms

Symptoms of left ventricular failure may be mild at first, and you might mistake them for a cold or allergy. You might not even notice them initially. However, as heart function worsens, you may experience^[2][3]:

• Shortness of breath during activity or when lying down
• Feeling tired most of the time and finding exercise exhausting
• Constant coughing or wheezing
• Waking up short of breath at night or being unable to lie flat
• Weight gain
• Swelling in your ankles, legs, or abdomen
• Feeling lightheaded or fainting
• Rapid or irregular heartbeat
• Reduced ability to exercise

During a physical examination, your doctor may notice specific signs linked to left heart failure. These can include crackling sounds in the lungs suggesting fluid buildup, an extra heart sound, visible swelling in neck veins, or an enlarged heart felt through the chest wall^[1].

Over time, as the heart works harder to do its job, complications may develop, including an enlarged heart, abnormal heart rhythms, or in severe cases, cardiogenic shock, which is when the heart suddenly cannot pump enough blood to meet the body’s needs^[2].

How Is It Diagnosed?

Healthcare providers diagnose left ventricular failure by taking a thorough medical history, performing a physical examination, and ordering laboratory tests and imaging studies^[2].

Blood tests can help detect signs of heart disease and rule out other causes of your symptoms. Your doctor may order^[2]:

• A BNP blood test to check for hormones that increase when there are pressure changes inside the heart
• A metabolic panel to check your kidney and liver function, along with measuring important minerals like sodium and potassium

Imaging tests create pictures of your heart to show how well it’s working. These may include^[2][3]:

• An electrocardiogram (EKG) to record and assess the heart’s electrical activity
• An echocardiogram (ECHO) to show heart movement and blood flow, and to measure ejection fraction
• Coronary angiography to examine the heart’s blood vessels
• Cardiac MRI to get a high-definition view of the heart
• Chest X-ray to show the condition of the lungs and heart

Sometimes stress tests or exercise tests may be done, which often involve walking on a treadmill or riding a stationary bike while your heart is monitored^[3].

Treatment Options

Treatment for left ventricular failure usually aims to control symptoms for as long as possible and slow down how quickly the condition gets worse. For most people, heart failure is a long-term condition that will require treatment for life^[3][8].

The specific treatments that are right for you depend on whether you have heart failure with preserved ejection fraction or heart failure with reduced ejection fraction^[2].

Medications are a key part of treatment and work to improve heart function. Many people need to take two or three different types of medicines^[2][3]. Common medications include:

• ACE inhibitors (drugs ending in “pril”), ARBs, or ARNIs, which relax blood vessels and help the heart work better
• Beta blockers (drugs ending in “olol”), which slow your heart rate and protect your heart
• Mineralocorticoid receptor antagonists (MRAs), which help remove excess fluid and lower blood pressure
• Diuretics (water pills), which make you pass more urine and help relieve swelling and breathlessness
• SGLT2 inhibitors, which help manage blood sugar and reduce strain on the heart
• Other medications such as ivabradine, sacubitril valsartan, hydralazine with nitrate, or digoxin

It’s very important to take your medications as directed every day, even when you feel good. If you experience side effects, talk to your healthcare team rather than stopping the medication on your own^[10].

Devices and procedures may be needed in some cases. These can include devices implanted in your chest to help control your heart rhythm, or surgery such as a bypass operation. In severe cases, a heart transplant or a device to help the heart pump blood may be necessary^[2][3].

Treatment will usually need to continue for the rest of your life. In some cases, when heart failure has a treatable cause, a cure may be possible. For example, if your heart valves are damaged, replacing or repairing them may cure the condition^[3].

Lifestyle Changes and Self-Care

Your lifestyle choices are just as important as any medication or procedure. Making healthy changes can help you feel better and slow the progression of your condition^[8][17].

Follow a healthy diet. A balanced diet should include plenty of fruits and vegetables (aim for at least 5 portions a day), meals based on starchy foods like potatoes, bread, rice or pasta, some dairy or dairy alternatives, and some beans, fish, eggs, meat and other protein sources. Keep saturated fat, salt and sugar intake low^[17].

Limit salt in your diet. Too much salt can make your body hold water like a sponge, causing your legs to swell and fluid to collect in your lungs. This makes your heart work harder. Aim to consume no more than a teaspoon of salt a day, including salt from packaged foods. Read food labels and choose foods with less than 140 mg of sodium per serving^[19].

Exercise regularly. 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 program. Before starting, you’ll have an assessment to find out how much exercise you can safely do^[17].

Stop smoking. If you smoke, quitting can improve your overall health and reduce your risk of many other health problems. Speak to your doctor if you need help quitting^[17].

Limit alcohol. You can usually continue to drink alcohol if you have heart failure, but it’s advisable not to exceed 14 alcohol units a week. If your heart failure is directly related to drinking alcohol, you may be advised to stop entirely^[17].

Monitor your weight. Weigh yourself regularly, as sudden weight changes can be a sign of a problem. Your care team will advise you about when and where to seek advice if there’s a potential issue^[17].

Take your medications as prescribed. Set up a system to help you remember, such as using a pill box with sections for different times of day, setting phone alarms, or asking people close to you to remind you^[19].

Get vaccinated. Heart failure can make you more vulnerable to infections. Everyone with heart failure should receive the annual flu vaccine and the one-off pneumococcal vaccination^[17].

Living With Left Ventricular Failure

Heart failure is a serious long-term condition that usually continues to get slowly worse over time. However, it’s very difficult to predict how the condition will progress for each individual person. Many people remain stable for many years, while in some cases it may worsen more quickly^[8].

You’ll have regular contact with your doctor or care team to monitor your condition at least every 6 months. These appointments provide an opportunity to discuss your symptoms, review your medications, and undergo tests to monitor your health. It’s also a good time to ask questions or raise any concerns^[17].

Having heart failure shouldn’t prevent you from traveling 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. It may be advisable to avoid traveling to high altitudes or hot, humid places, as these may put extra strain on your heart. If you’re flying, inform the airline of your condition, and they may provide assistance^[17].

While heart failure can severely limit the activities you’re able to do and is often eventually fatal, proper treatment can improve symptoms and may help some people live longer. With the right combination of medications, lifestyle changes, and medical support, many people with left ventricular failure can maintain a good quality of life for years^[3][8].