If a person has left sided heart failure, the left side of their heart does not fill with enough blood or pump it effectively. Left sided heart failure can lead to right sided heart failure.

Heart failure occurs when cardiac output is insufficient to circulate the blood the body needs.

Ejection fraction (EF) is a measurement of cardiac output. EF is the percentage of blood in the left ventricle that it can pump out with each contraction.

The target range for EF is 55–70%. If a person’s left ventricle pumps less than 40% of its blood with each contraction, this may indicate heart failure.

Heart failure can occur on the left side of the heart, the right side, or both.

This article discusses left sided heart failure, including causes, diagnosis, treatment, and outlook.

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There are two kinds of left sided heart failure.

For circulation to occur, the heart must be able to fill with blood, then pump it. Left sided heart failure can interfere with both filling and pumping.

Diastolic failure

Diastolic failure prevents the heart from filling with blood.

This is because the heart muscle has become too stiff for the left ventricle to relax properly between contractions, which is when filling usually occurs.

Diastolic failure is also known as heart failure with preserved ejection fraction (HFpEF).

Systolic failure

Systolic failure interferes with the heart’s ability to pump blood.

It occurs when the left ventricle does not contract properly. This is also known as heart failure with reduced ejection fraction (HFrEF).

Because of the loss of proper left ventricle contraction, the heart pumps 40% EF or less. This is not enough to maintain adequate circulation throughout the body.

Left sided heart failure results in an accumulation of blood in the vessels that usually carry blood away from the lungs.

So, some symptoms may involve breathing, such as:

  • coughing, particularly during physical activity
  • shortness of breath
  • breathlessness while lying down or at nighttime

Other symptoms include:

  • leg swelling
  • increased abdominal width
  • weight gain
  • upper right torso pain

What is the primary symptom of left sided heart failure?

According to the American Heart Association, shortness of breath (dyspnea) tops the list of the most common symptoms of heart failure.

Dyspnea occurs most often during physical activity. It can also happen at night, prompting a person to get up from lying down to breathe more easily.

Coronary artery disease and long-term high blood pressure are the leading causes of left sided heart failure.

Heart attack can also cause this type of heart failure.

Left sided heart failure risk factors include:

  • tobacco use
  • diabetes
  • overweight and obesity
  • low physical activity
  • being male
  • advanced age

Doctors can diagnose left sided heart failure in several ways.

Physical exam

Heart failure signs doctors look for include:

  • certain heart rhythm changes
  • sounds from fluid in the lungs
  • breathing problems from fluid around the lungs
  • bulging in the neck blood vessels
  • increased jugular vessel pressure from liver congestion
  • increased heart size
  • scrotal swelling
  • abdominal girth increase
  • rapid heart rate with low blood pressure

Blood tests

Blood tests that can help identify heart failure include:

  • brain natriuretic peptide (BNP)
  • troponin T
  • basic metabolic panel
  • complete blood count (CBC)
  • liver function tests

Electrocardiogram (EKG)

An EKG measures the heart’s electrical activity and can detect abnormal heart rhythms. It can also identify whether the left ventricle is enlarged.

Imaging tests

Doctors also use imaging tests to look for signs of heart failure, including:

  • Coronary angiogram: A coronary angiogram checks the function of the blood vessels that bring oxygenated blood to the heart. Blockages in these vessels can lead to heart failure.
  • Echocardiogram: An echocardiogram is an ultrasound of the heart. It can measure EF, detect problems with ventricle contraction and relaxation, and detect other issues, such as valve abnormalities.
  • Chest X-ray: An X-ray uses ionizing radiation to create images of the structures inside the body.
  • CT scan: A CT scan is a type of X-ray that shows more detail because it uses a series of images instead of just one. CT scans can occur with or without contrast dye, depending on the scan’s purpose.
  • MRI scan: Radio waves and magnetic energy from an MRI scanner create computerized imagery of the body.

Left sided heart failure has several treatments:

  • Lifestyle strategies and changes: Eating a low salt diet with plenty of vegetables and fruits, getting regular physical activity, and avoiding alcohol and smoking can help manage heart health.
  • Medications: Heart failure medications can slow the heart rate, reduce fluid and sodium levels, relax the blood vessels, and help the heart pump stronger.
  • Manage other health conditions: Treating and managing blood pressure and arrhythmias can help address factors that contribute to heart failure.
  • Implantable device: A person with an EF of less than 35% may benefit from an implantable cardioverter defibrillator (ICD) or pacemaker.
  • Transplantation: People with advanced heart failure may be eligible for a heart transplant.

Left sided heart failure can cause complications, including:

  • respiratory distress
  • interstitial fluid accumulation
  • arrhythmias
  • cardiogenic shock
  • pulmonary embolism
  • stroke
  • acute coronary syndrome
  • myocardium rupture

Left sided heart failure can also lead to death, but treating and managing it can extend a person’s life.

The outlook for left sided heart failure can vary. It can improve or become life threatening based on factors such as:

  • symptom severity
  • whether a person follows their treatment plan or makes recommended lifestyle changes
  • age
  • sex
  • underlying factors, such as blood pressure or kidney function

It is possible for a person to live 10 years or more after a heart failure diagnosis.

The following lifestyle strategies may help prevent left sided heart failure:

  • regular exercise
  • high quality sleep
  • a diet that includes more fruits, vegetables, and whole grains and less salt
  • blood pressure management
  • not smoking
  • reducing and managing stress

Left sided heart failure can lead to weakness on the heart’s right side.

It is possible for right sided heart failure to occur on its own because of lung disease. However, most of the time, it starts from left ventricle problems.

Is left sided heart failure worse?

Left sided heart failure is worse and more common than right sided heart failure.

Right sided heart failure impairs the heart’s ability to pump blood to the lungs. Left sided heart failure reduces circulation in the entire body because the left ventricle is the heart’s main pumping chamber.

Left sided heart failure is the most common kind of heart failure. The left ventricle, where this heart failure begins, is the heart’s strongest pumping chamber.

Coronary artery disease and long-term unmanaged high blood pressure are the leading causes of left sided heart failure.

Treatment includes lifestyle strategies, medications, implantable defibrillators or pacemakers, and transplant surgery, in severe cases.

If a person follows their treatment plan, they can manage their heart failure and live for many years after their diagnosis.