Alternate Names: Congestive heart failure - left

Causes and Risks:

Heart failure may affect the right side, left side, or both sides of the heart. The left side of the heart receives oxygenated blood from the lungs and pumps it to the body. As pumping effectiveness decreases in the left side of the heart, blood may back up into the lungs and blood flow to the body may be insufficient. Eventually right sided heart failure may develop.

Structural or functional causes of heart failure include high blood pressure (hypertension), coronary artery disease, heart valve disease, congenital heart diseases, cardiomyopathy, heart tumor, and other heart diseases. When a person is predisposed to heart failure, then anything that increases stress to the heart may result in acute symptoms.

In children, congenital malformation of the heart or its valves (congenital heart disease) is the most common cause of left-sided heart failure. Vascular malformations (abnormalities of the blood vessels) are also common causes of heart failure in children.

Precipitating factors include: elevation of blood pressure; increased activity; increased fluids; increased salt intake; high fever or complicated infections; anemia; irregular heartbeats (arrhythmias); hyperthyroidism; kidney disease; medications that affect contraction of the heart muscle (such as beta blockers or calcium channel blockers); and stopping "treatment" medications (such as ACE inhibitors, digoxin, diuretics).

Other risk factors include obesity, excess alcohol consumption, and eating a diet high in salt.

Left-sided heart failure occurs in approximately 1-3 out of 100 people and becomes more prevalent with advancing age.

Prevention: Follow the health care provider’s advice for treatment of conditions that may cause congestive heart failure. Follow dietary guidelines, and minimize or eliminate smoking and alcohol consumption.

Symptoms:

• Shortness of breath, with activity or when lying down
• Difficulty lying down; need to sleep with the head elevated to avoid shortness of breath
• Sensation of feeling the heartbeat (palpitations)
• Irregular or rapid pulse
• Cough (produces frothy or blood-tinged mucus)
• Fatigue, weakness, faintness
• Decreased urine production (oliguria)
• Infants may have poor feeding, weight loss, and failure to thrive

Signs and Tests: Physical examination may reveal irregular or rapid heartbeat. A heart murmur may be present. Respiratory rate may be increased above 20 breaths per minute (greater than 60 breaths per minute in infants). There may signs of pleural effusion (fluid around the lungs). Listening to the chest (auscultation) may reveal lung crackles or abnormal heart sounds.

An ECG may show enlargement of the heart or arrhythmias. Enlargement of the heart or decreased heart functioning may be seen on these tests:

• Chest X-ray
• Echocardiogram

• Chest CT scan
• Heart catheterization
• Coronary angiography

Multiple laboratory studies may be performed, including CBC, blood chemistry, urinalysis, and others to determine the cause and effects of heart failure.

Treatment: The goals of treatment include reduction of cardiac workload, control of symptoms, and improvement of heart functioning.

Heart failure requires monitoring of the condition by the health care provider. A cardiac specialist (cardiologist) should be consulted. Hospitalization may be required if symptoms are severe or unstable, difficulty breathing occurs at rest or with minimal activity, or there is little response to initial treatment.

Underlying disorders and precipitating factors should be treated. This may require medications, surgery, or behavior modification.

Treatment may include:

• Behavior modification
• Decreased dietary sodium (salt)
• Decreased fluid intake
• Moderate exercise

Bedrest or reduced physical activity may be recommended in severe or stubborn (refractory) cases to minimize the heart’s workload.

Medications include diuretics to reduce fluids in the body, and vasodilators to reduce the workload of the heart (examples include captopril, enalapril, and losartan).

During acute heart failure, intravenous medications may be necessary. These include inotropic drugs, vasodilator drugs, and diuretics. Mechanical fluid removal (thoracentesis or paracentesis) may be necessary. Dialysis may be performed to remove excess fluid in severe cases.

Circulatory assist devices such as the intraaortic balloon pump or a left-ventricular-assist device may be recommended to stabilize the condition. In extreme cases, a heart transplant may be considered.

Long-term recommendations may include:

• Weight loss
• Eliminating smoking and alcohol consumption (both decrease the pumping efficiency of the heart)
• Repair of any underlying structural heart or heart valve malformation that is present

Prognosis: Heart failure is a serious disorder that carries a possibility of reduced life expectancy. There is no cure, but many forms of heart failure are well controlled with medication and correction of underlying disorders. It may take the form of a chronic illness. Heart failure worsens with infection or other physical stressors.

Complications:

• Pulmonary edema
• Total failure of the heart to function (circulatory collapse)
• Arrhythmias including lethal arrhythmias
• Side effects of medications
  • Low blood pressure (hypotension)
  • Lightheadedness, fainting
  • Headache
  • GI upset
  • Digitalis toxicity
  • Electrolyte imbalance

Call your health care provider if symptoms indicating congestive heart failure may be present.

Call your health care provider if you experience chest pain, weakness, fainting, rapid or irregular heartbeat, increased cough or sputum production, sudden weight gain or swelling.

Call your baby’s health care provider if the infant has weight loss, poor feeding, or does not appear to be growing or developing normally.