Left heart failure, also known as left-sided heart failure or congestive heart failure (CHF), is a condition in which the left side of the heart is unable to pump blood effectively, leading to a backlog of blood in the lungs and an inadequate supply of oxygen-rich blood to the body’s organs and tissues.
The heart is divided into two main chambers on each side: the atrium and the ventricle. The left side of the heart is responsible for pumping oxygenated blood from the lungs to the rest of the body.
Epidemiology
Heart failure is common, and left heart failure is the most common type. The prevalence of heart failure tends to increase with age, and it is more common in older adults. Heart failure is known to have a somewhat higher prevalence in men than women. However, the difference in prevalence narrows with advancing age, and after age 65, the incidence becomes similar in both genders. There are variations in the prevalence and outcomes of heart failure among different racial and ethnic groups.
For example, heart failure has been reported to be more common in African Americans than Caucasians. Additionally, treatment outcomes and responses may vary among racial and ethnic populations. Left heart failure is a common reason for hospitalization, and hospital admissions related to heart failure are associated with a significant economic burden on healthcare systems. Heart failure is associated with high mortality rates, and left heart failure is a leading cause of cardiovascular-related deaths.
However, advancements in medical therapy and interventions have improved survival rates and quality of life for individuals with heart failure. Heart failure is a global health issue affecting millions of people worldwide. The burden of heart failure is expected to increase due to aging populations, changes in lifestyle, and the increasing prevalence of cardiovascular risk factors.
Anatomy
Pathophysiology
Various mechanisms can contribute to the development of left heart failure. Persistent or uncontrolled hypertension increases afterload, elevating cardiac workload and inducing left ventricular hypertrophy. While initially serving as a compensatory mechanism to maintain cardiac output, prolonged hypertrophy impedes myocardial relaxation, leading to impaired cardiac filling and reduced left ventricular output. Chronic or poorly managed hypertension is not the only culprit; coronary arterial disease introduces direct ischemic damage to the myocardium.
This damage prompts remodeling and scar formation, diminishing contractility and cardiac output. Arrhythmias, on the other hand, induce remodeling, generally leading to decreased cardiac output by disrupting ventricular filling and impairing ventricular relaxation. Cardiomyopathies represent a broad range of pathologies with diverse mechanisms contributing to cardiac dysfunction. This variability underscores the complexity of factors that can lead to left heart failure.
Etiology
Hypertension: Chronic or poorly controlled hypertension is a major contributor to left heart failure. Elevated blood pressure increases the workload on the left ventricle, leading to hypertrophy of the heart muscle. Over time, this can impair the heart’s ability to pump effectively.
Myocardial Infarction: Acute myocardial infarctions result from a sudden blockage of blood flow to a part of the heart. This can cause significant damage to the myocardium, affecting its contractility and overall function, ultimately contributing to heart failure.
Cardiomyopathies: These are diseases that directly affect the heart muscle, leading to structural and functional abnormalities. Dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy are examples of conditions that can cause left heart failure.
Genetic Factors: In some cases, genetic predispositions can contribute to the development of cardiomyopathies and other heart conditions that increase the risk of left heart failure.
Environmental Factors: Lifestyle factors such as smoking, excessive alcohol consumption, and a sedentary lifestyle can contribute to developing and progressing cardiovascular diseases that lead to left heart failure.
Genetics
Prognostic Factors
Clinical History
A hallmark symptom is progressive dyspnea, especially during physical activity or when lying down. Patients may experience persistent fatigue and weakness. Edema may occur, leading to swelling in the legs, ankles, and sometimes the abdomen. A chronic cough, often with pink or bloody sputum, can indicate fluid accumulation in the lungs. Palpitations or an irregular pulse may be present.
Left ventricular heart failure often develops gradually. Patients may not notice symptoms until the condition has progressed. The duration can vary based on the underlying cause and how promptly the condition is diagnosed and managed. Some individuals may have a long-standing history of cardiovascular risk factors before developing heart failure, while others may experience a more acute onset, especially in the context of a myocardial infarction.
Physical Examination
Visible distension of the jugular veins in the neck may indicate elevated pressure in the heart. Swelling in the extremities, particularly in the legs and ankles, due to fluid retention. Abnormal lung sounds heard during auscultation indicate fluid accumulation in the lungs. An extra heart sound, often referred to as an “S3,” may be audible during cardiac auscultation.
It is associated with rapid filling of the ventricle and is a sign of impaired ventricular function. Tachycardia is observed in response to the decreased effectiveness of each contraction. Hepatomegaly, ascites, and cyanosis are also observed. Sudden onset of severe shortness of breath during sleep, often leading the individual to wake up gasping for breath, is commonly experienced by most patients.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Pulmonary Hypertension
Nephrotic Syndrome
Lymphedema
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Patients should be educated on the critical role of lifestyle modifications in improving the outcomes of their condition. This includes maintaining a reasonable salt intake and abstaining from nicotine, alcohol, and recreational drugs. Addressing the underlying cause is paramount, as certain heart failure conditions may be reversible when precipitating factors are targeted, such as cardiomyopathies induced by alcohol, tachycardia, or ischemia. Tight control of blood pressure is also crucial in preventing further deterioration.
For HFrEF, the cornerstone of treatment involves a combination of an angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers with a beta-blocker. If the patient remains symptomatic on a maximal ACE inhibitor or ARB dose, an angiotensin receptor-neprilysin inhibitor may be considered. Other medications include nitrates, hydralazine, mineralocorticoid receptor antagonists like spironolactone, digoxin, and ivabradine (as a last resort). Nitrates, in combination with hydralazine may be particularly effective in African American patients.
Valve Repair or Replacement: In cases of severe valvular heart disease.
Left Ventricular Assist Device (LVAD): For advanced heart failure, an LVAD can assist the heart in pumping blood.
Heart Transplant: In cases of end-stage heart failure, heart transplantation may be considered.
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
lifestyle-modifications
A heart-healthy diet that is low in sodium can help manage fluid retention. This often involves reducing salt intake. In some cases, limiting fluid intake may be recommended to manage edema and fluid overload.
Regular, moderate exercise is encouraged, but the type and intensity should be tailored to the individual’s capabilities. Avoidance of excessive physical exertion is important.Â
Left heart failure, also known as left-sided heart failure or congestive heart failure (CHF), is a condition in which the left side of the heart is unable to pump blood effectively, leading to a backlog of blood in the lungs and an inadequate supply of oxygen-rich blood to the body’s organs and tissues.
The heart is divided into two main chambers on each side: the atrium and the ventricle. The left side of the heart is responsible for pumping oxygenated blood from the lungs to the rest of the body.
Heart failure is common, and left heart failure is the most common type. The prevalence of heart failure tends to increase with age, and it is more common in older adults. Heart failure is known to have a somewhat higher prevalence in men than women. However, the difference in prevalence narrows with advancing age, and after age 65, the incidence becomes similar in both genders. There are variations in the prevalence and outcomes of heart failure among different racial and ethnic groups.
For example, heart failure has been reported to be more common in African Americans than Caucasians. Additionally, treatment outcomes and responses may vary among racial and ethnic populations. Left heart failure is a common reason for hospitalization, and hospital admissions related to heart failure are associated with a significant economic burden on healthcare systems. Heart failure is associated with high mortality rates, and left heart failure is a leading cause of cardiovascular-related deaths.
However, advancements in medical therapy and interventions have improved survival rates and quality of life for individuals with heart failure. Heart failure is a global health issue affecting millions of people worldwide. The burden of heart failure is expected to increase due to aging populations, changes in lifestyle, and the increasing prevalence of cardiovascular risk factors.
Various mechanisms can contribute to the development of left heart failure. Persistent or uncontrolled hypertension increases afterload, elevating cardiac workload and inducing left ventricular hypertrophy. While initially serving as a compensatory mechanism to maintain cardiac output, prolonged hypertrophy impedes myocardial relaxation, leading to impaired cardiac filling and reduced left ventricular output. Chronic or poorly managed hypertension is not the only culprit; coronary arterial disease introduces direct ischemic damage to the myocardium.
This damage prompts remodeling and scar formation, diminishing contractility and cardiac output. Arrhythmias, on the other hand, induce remodeling, generally leading to decreased cardiac output by disrupting ventricular filling and impairing ventricular relaxation. Cardiomyopathies represent a broad range of pathologies with diverse mechanisms contributing to cardiac dysfunction. This variability underscores the complexity of factors that can lead to left heart failure.
Hypertension: Chronic or poorly controlled hypertension is a major contributor to left heart failure. Elevated blood pressure increases the workload on the left ventricle, leading to hypertrophy of the heart muscle. Over time, this can impair the heart’s ability to pump effectively.
Myocardial Infarction: Acute myocardial infarctions result from a sudden blockage of blood flow to a part of the heart. This can cause significant damage to the myocardium, affecting its contractility and overall function, ultimately contributing to heart failure.
Cardiomyopathies: These are diseases that directly affect the heart muscle, leading to structural and functional abnormalities. Dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy are examples of conditions that can cause left heart failure.
Genetic Factors: In some cases, genetic predispositions can contribute to the development of cardiomyopathies and other heart conditions that increase the risk of left heart failure.
Environmental Factors: Lifestyle factors such as smoking, excessive alcohol consumption, and a sedentary lifestyle can contribute to developing and progressing cardiovascular diseases that lead to left heart failure.
A hallmark symptom is progressive dyspnea, especially during physical activity or when lying down. Patients may experience persistent fatigue and weakness. Edema may occur, leading to swelling in the legs, ankles, and sometimes the abdomen. A chronic cough, often with pink or bloody sputum, can indicate fluid accumulation in the lungs. Palpitations or an irregular pulse may be present.
Left ventricular heart failure often develops gradually. Patients may not notice symptoms until the condition has progressed. The duration can vary based on the underlying cause and how promptly the condition is diagnosed and managed. Some individuals may have a long-standing history of cardiovascular risk factors before developing heart failure, while others may experience a more acute onset, especially in the context of a myocardial infarction.
Visible distension of the jugular veins in the neck may indicate elevated pressure in the heart. Swelling in the extremities, particularly in the legs and ankles, due to fluid retention. Abnormal lung sounds heard during auscultation indicate fluid accumulation in the lungs. An extra heart sound, often referred to as an “S3,” may be audible during cardiac auscultation.
It is associated with rapid filling of the ventricle and is a sign of impaired ventricular function. Tachycardia is observed in response to the decreased effectiveness of each contraction. Hepatomegaly, ascites, and cyanosis are also observed. Sudden onset of severe shortness of breath during sleep, often leading the individual to wake up gasping for breath, is commonly experienced by most patients.
Pulmonary Hypertension
Nephrotic Syndrome
Lymphedema
Patients should be educated on the critical role of lifestyle modifications in improving the outcomes of their condition. This includes maintaining a reasonable salt intake and abstaining from nicotine, alcohol, and recreational drugs. Addressing the underlying cause is paramount, as certain heart failure conditions may be reversible when precipitating factors are targeted, such as cardiomyopathies induced by alcohol, tachycardia, or ischemia. Tight control of blood pressure is also crucial in preventing further deterioration.
For HFrEF, the cornerstone of treatment involves a combination of an angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers with a beta-blocker. If the patient remains symptomatic on a maximal ACE inhibitor or ARB dose, an angiotensin receptor-neprilysin inhibitor may be considered. Other medications include nitrates, hydralazine, mineralocorticoid receptor antagonists like spironolactone, digoxin, and ivabradine (as a last resort). Nitrates, in combination with hydralazine may be particularly effective in African American patients.
Valve Repair or Replacement: In cases of severe valvular heart disease.
Left Ventricular Assist Device (LVAD): For advanced heart failure, an LVAD can assist the heart in pumping blood.
Heart Transplant: In cases of end-stage heart failure, heart transplantation may be considered.
Cardiology, General
A heart-healthy diet that is low in sodium can help manage fluid retention. This often involves reducing salt intake. In some cases, limiting fluid intake may be recommended to manage edema and fluid overload.
Regular, moderate exercise is encouraged, but the type and intensity should be tailored to the individual’s capabilities. Avoidance of excessive physical exertion is important.Â
medtigo
Left heart failure
Updated :
May 22, 2024
Left heart failure, also known as left-sided heart failure or congestive heart failure (CHF), is a condition in which the left side of the heart is unable to pump blood effectively, leading to a backlog of blood in the lungs and an inadequate supply of oxygen-rich blood to the body’s organs and tissues.
The heart is divided into two main chambers on each side: the atrium and the ventricle. The left side of the heart is responsible for pumping oxygenated blood from the lungs to the rest of the body.
Heart failure is common, and left heart failure is the most common type. The prevalence of heart failure tends to increase with age, and it is more common in older adults. Heart failure is known to have a somewhat higher prevalence in men than women. However, the difference in prevalence narrows with advancing age, and after age 65, the incidence becomes similar in both genders. There are variations in the prevalence and outcomes of heart failure among different racial and ethnic groups.
For example, heart failure has been reported to be more common in African Americans than Caucasians. Additionally, treatment outcomes and responses may vary among racial and ethnic populations. Left heart failure is a common reason for hospitalization, and hospital admissions related to heart failure are associated with a significant economic burden on healthcare systems. Heart failure is associated with high mortality rates, and left heart failure is a leading cause of cardiovascular-related deaths.
However, advancements in medical therapy and interventions have improved survival rates and quality of life for individuals with heart failure. Heart failure is a global health issue affecting millions of people worldwide. The burden of heart failure is expected to increase due to aging populations, changes in lifestyle, and the increasing prevalence of cardiovascular risk factors.
Various mechanisms can contribute to the development of left heart failure. Persistent or uncontrolled hypertension increases afterload, elevating cardiac workload and inducing left ventricular hypertrophy. While initially serving as a compensatory mechanism to maintain cardiac output, prolonged hypertrophy impedes myocardial relaxation, leading to impaired cardiac filling and reduced left ventricular output. Chronic or poorly managed hypertension is not the only culprit; coronary arterial disease introduces direct ischemic damage to the myocardium.
This damage prompts remodeling and scar formation, diminishing contractility and cardiac output. Arrhythmias, on the other hand, induce remodeling, generally leading to decreased cardiac output by disrupting ventricular filling and impairing ventricular relaxation. Cardiomyopathies represent a broad range of pathologies with diverse mechanisms contributing to cardiac dysfunction. This variability underscores the complexity of factors that can lead to left heart failure.
Hypertension: Chronic or poorly controlled hypertension is a major contributor to left heart failure. Elevated blood pressure increases the workload on the left ventricle, leading to hypertrophy of the heart muscle. Over time, this can impair the heart’s ability to pump effectively.
Myocardial Infarction: Acute myocardial infarctions result from a sudden blockage of blood flow to a part of the heart. This can cause significant damage to the myocardium, affecting its contractility and overall function, ultimately contributing to heart failure.
Cardiomyopathies: These are diseases that directly affect the heart muscle, leading to structural and functional abnormalities. Dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy are examples of conditions that can cause left heart failure.
Genetic Factors: In some cases, genetic predispositions can contribute to the development of cardiomyopathies and other heart conditions that increase the risk of left heart failure.
Environmental Factors: Lifestyle factors such as smoking, excessive alcohol consumption, and a sedentary lifestyle can contribute to developing and progressing cardiovascular diseases that lead to left heart failure.
A hallmark symptom is progressive dyspnea, especially during physical activity or when lying down. Patients may experience persistent fatigue and weakness. Edema may occur, leading to swelling in the legs, ankles, and sometimes the abdomen. A chronic cough, often with pink or bloody sputum, can indicate fluid accumulation in the lungs. Palpitations or an irregular pulse may be present.
Left ventricular heart failure often develops gradually. Patients may not notice symptoms until the condition has progressed. The duration can vary based on the underlying cause and how promptly the condition is diagnosed and managed. Some individuals may have a long-standing history of cardiovascular risk factors before developing heart failure, while others may experience a more acute onset, especially in the context of a myocardial infarction.
Visible distension of the jugular veins in the neck may indicate elevated pressure in the heart. Swelling in the extremities, particularly in the legs and ankles, due to fluid retention. Abnormal lung sounds heard during auscultation indicate fluid accumulation in the lungs. An extra heart sound, often referred to as an “S3,” may be audible during cardiac auscultation.
It is associated with rapid filling of the ventricle and is a sign of impaired ventricular function. Tachycardia is observed in response to the decreased effectiveness of each contraction. Hepatomegaly, ascites, and cyanosis are also observed. Sudden onset of severe shortness of breath during sleep, often leading the individual to wake up gasping for breath, is commonly experienced by most patients.
Pulmonary Hypertension
Nephrotic Syndrome
Lymphedema
Patients should be educated on the critical role of lifestyle modifications in improving the outcomes of their condition. This includes maintaining a reasonable salt intake and abstaining from nicotine, alcohol, and recreational drugs. Addressing the underlying cause is paramount, as certain heart failure conditions may be reversible when precipitating factors are targeted, such as cardiomyopathies induced by alcohol, tachycardia, or ischemia. Tight control of blood pressure is also crucial in preventing further deterioration.
For HFrEF, the cornerstone of treatment involves a combination of an angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers with a beta-blocker. If the patient remains symptomatic on a maximal ACE inhibitor or ARB dose, an angiotensin receptor-neprilysin inhibitor may be considered. Other medications include nitrates, hydralazine, mineralocorticoid receptor antagonists like spironolactone, digoxin, and ivabradine (as a last resort). Nitrates, in combination with hydralazine may be particularly effective in African American patients.
Valve Repair or Replacement: In cases of severe valvular heart disease.
Left Ventricular Assist Device (LVAD): For advanced heart failure, an LVAD can assist the heart in pumping blood.
Heart Transplant: In cases of end-stage heart failure, heart transplantation may be considered.
Cardiology, General
A heart-healthy diet that is low in sodium can help manage fluid retention. This often involves reducing salt intake. In some cases, limiting fluid intake may be recommended to manage edema and fluid overload.
Regular, moderate exercise is encouraged, but the type and intensity should be tailored to the individual’s capabilities. Avoidance of excessive physical exertion is important.Â
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