Chronic Left Ventricular Failure

Chronic left ventricular failure is a long-term condition where the left side of your heart cannot pump blood effectively enough to meet your body’s needs, causing blood and fluid to back up in your lungs and other parts of your body.

Table of contents

• What is chronic left ventricular failure?
• Types of left ventricular failure
• How the heart works
• What causes this condition?
• Risk factors
• Signs and symptoms
• Possible complications
• How is it diagnosed?
• Treatment options
• Living with the condition
• What to expect

What is chronic left ventricular failure?

Chronic left ventricular failure happens when the left side of your heart no longer works properly over a long period of time. The heart is made up of different layers, including the outer covering, the middle muscle layer, and the inner lining. Damage to any of these parts can lead to heart failure.^[1]

When the left ventricle (the bottom pumping chamber on the left side of your heart) fails, it cannot pump enough blood to deliver oxygen to your body’s vital organs. Your heart is still working, but it cannot handle the amount of blood it should. This causes blood to build up in other parts of your body, most commonly in your lungs, legs, and feet.^[2]

This condition is long-term and tends to get gradually worse over time. It cannot usually be cured, but symptoms can often be controlled for many years with proper treatment.^[1]

Types of left ventricular failure

There are two main types of chronic left ventricular failure, based on how the heart muscle is affected:^[1]

Systolic heart failure, also known as heart failure with reduced ejection fraction, occurs when the left ventricle becomes too weak to pump blood out to your body effectively. The ejection fraction (the percentage of blood leaving your heart each time it contracts) is less than 40%.^[2]

Diastolic heart failure, also called heart failure with preserved ejection fraction, happens when the left ventricle becomes stiff and cannot relax properly. This makes it difficult for the chamber to fill with blood, even though the ejection fraction remains over 50%.^[1]

Some people may have heart failure with mid-range ejection fraction, where the ejection fraction falls between 41 and 49%.^[2]

How the heart works

The two sides of your heart work in different ways to pump blood throughout your body.^[1]

The left side receives oxygen-rich blood from your lungs and delivers it to the rest of your body. The oxygen in this blood helps your organs, muscles, and other tissues do their jobs properly.

The right side receives oxygen-poor blood from your body and sends it to your lungs. In the lungs, you release carbon dioxide and take in more oxygen, and the cycle continues.

What causes this condition?

The most common causes of chronic left ventricular failure are coronary artery disease (when the arteries that supply blood to the heart become clogged with fatty substances) and high blood pressure.^[2]

High blood pressure can lead to left ventricular failure in two ways. It can cause the left ventricle to become thicker and larger over time, which eventually makes it stiff and unable to relax properly. High blood pressure also increases your risk of developing coronary artery disease, which can damage the heart muscle directly.^[2]

Other conditions that can lead to chronic left ventricular failure include:^[1]

• Heart attack
• Problems with heart valves
• Abnormal heart rhythms
• Diseases that affect the heart muscle, such as amyloid disease and sarcoidosis
• Heart problems present from birth

Risk factors

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

• Diabetes
• Being overweight or obese
• Smoking
• Living an inactive lifestyle with little physical activity
• Being a man
• Older age
• Sleep apnea (a condition where breathing stops and starts during sleep)
• Certain chemotherapy treatments for cancer
• Using substances that harm the heart, such as certain drugs and energy drinks
• Some medications used to treat other conditions, such as autoimmune diseases and attention problems

Many of these risk factors can be prevented or controlled, which is why managing them is extremely important in preventing heart failure.^[2]

Signs and symptoms

Symptoms of chronic left ventricular failure may be mild at first, or you may think you have a cold or allergy. You might not even notice them initially. However, as the condition worsens, symptoms become more noticeable.^[1]

Common symptoms include:^[1]

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

During a physical examination, your doctor might notice specific signs linked to left ventricular failure. These may include crackling sounds in the lungs (suggesting fluid buildup), decreased lung sounds, an extra heart sound, visible neck veins, or increased pressure when pressing on your abdomen.^[8]

Possible complications

Over time, as your heart works harder to do its job, chronic left ventricular failure can cause serious complications:^[1]

• An enlarged heart
• Abnormal heart rates and rhythms
• Cardiogenic shock (a life-threatening condition where the heart suddenly cannot pump enough blood)
• Right-sided heart failure (left-sided heart failure is the most common cause of right-sided heart failure)
• Kidney damage
• Liver damage
• Heart valve problems
• Fluid collection in the lungs

How is it diagnosed?

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

Laboratory tests use a sample of your blood to detect signs of heart disease and rule out other causes of your symptoms. These may include:^[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 important minerals like sodium and potassium

Imaging studies allow doctors to see how your heart is working. Heart imaging tests you may need include:^[1]

• Electrocardiogram (EKG) to record and assess the heart’s electrical activity
• Echocardiogram (ECHO) to show heart movement, blood flow, and the size and structure of your heart and heart valves
• 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 your lungs and heart

Treatment options

Treatment for chronic left ventricular failure aims to control symptoms for as long as possible and slow down the progression of the condition. The right treatment for you depends on whether you have systolic or diastolic heart failure, and how serious your condition is.^[1]

Lifestyle changes are an important part of managing heart failure. Healthcare providers may recommend:^[10]

• Lowering your sodium (salt) intake, as salt can make fluid buildup worse
• Aiming for a healthy weight, since extra weight makes your heart work harder
• Getting regular physical activity (ask your healthcare provider about the right activity level for you)
• Quitting smoking
• Avoiding or limiting alcohol
• Managing other health conditions like diabetes and high blood pressure

Medications are used to improve heart functioning. Many people need to take two or three different types of medicines. Common medications include:^[1][11]

• ACE inhibitors or angiotensin II receptor blockers (ARBs) or angiotensin-receptor neprilysin inhibitors (ARNIs) that relax blood vessels and make it easier for your heart to pump blood
• Beta blockers that slow your heart down and protect it from the effects of stress hormones
• Mineralocorticoid receptor antagonists (MRAs) that help you pass more urine and lower blood pressure
• Diuretics (water pills) that make you pass more urine and help relieve ankle swelling and breathlessness
• SGLT2 inhibitors, a newer class of medication that can help with heart failure
• Other medications like ivabradine, digoxin, or hydralazine with nitrate may be used in specific situations

You may need to try several different medicines before finding a combination that controls your symptoms without causing unpleasant side effects.^[11]

Devices and procedures may be needed in some cases:^[1]

• Devices implanted in your chest to help control your heart rhythm
• Surgery, such as bypass operations or procedures to repair heart valves
• Heart transplant in very severe cases

Treatment usually needs to continue for the rest of your life.^[11]

Living with the condition

Living with chronic left ventricular failure means taking an active role in your care. You should learn about your condition and how lifestyle changes and medicines work together to help you feel better, stay out of the hospital, and live longer.^[21]

Self-care practices are essential for managing your condition day to day:^[23]

• Take your medicines exactly as prescribed
• Weigh yourself every day at the same time, using the same scale. Weight gain may be a sign that your body is holding too much fluid
• Keep a daily record of your symptoms to help you notice if they change or get worse
• Watch for warning signs that your condition may be worsening

Know when to call your doctor: Contact your healthcare provider if you notice:^[23]

• Sudden weight gain (such as more than 1 to 1.3 kilograms in a day or two)
• New or worse swelling in your feet, ankles, or legs
• Breathing that gets worse
• Breathing when lying down is worse than usual, or you wake up at night needing to catch your breath

Emergency symptoms: Call emergency services immediately if you have severe shortness of breath, an irregular or fast heartbeat, or cough up foamy, pink mucus.^[23]

Regular monitoring: You will have regular contact with your doctor or care team to monitor your condition at least every six months. These appointments help check how well your treatment is working and allow you to ask questions.^[19]

Having chronic left ventricular failure should not 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.^[19]

What to expect

Chronic left ventricular failure is a serious long-term condition that usually continues to get slowly worse over time. However, with proper treatment and self-care, many people remain stable for many years.^[6]

The condition affects approximately 5.7 million people in the United States. It is more common and has a higher occurrence in older people, with a rate of about 10 cases per 1,000 people over age 65.^[2]

Heart failure with reduced ejection fraction is more common in men and accounts for about 50% of all heart failure cases. Heart failure with preserved ejection fraction is more common in women (79% versus 49%) and tends to affect an older population.^[2]

While the condition can severely limit the activities you are able to do, treatment can help you live a longer, more active life with fewer symptoms. The outlook varies greatly from person to person, and it is difficult to predict how the condition will progress for any individual.^[6]

• Left ventricle
• Heart
• Lungs