Left heart failure is also known as heart muscle weakness. The heart disease affects the left ventricle, and there is an inability to meet the demands of blood circulation.
What is left heart failure?
The inability of the left heart to pump enough blood into the circulation causes blood to back up into the lungs. The disease symptoms of left heart failure are also derived from this pathophysiologic event. As a rule, heart failure always starts on the left side of the heart. If the disease progresses, the right heart is eventually affected as well. The physician then speaks of right heart failure. If the entire heart muscle is affected by a weakness, this is called global insufficiency. The term left heart failure therefore means an insufficient performance or working capacity of the left heart in relation to the requirements of the entire blood circulation. Depending on the degree of left heart failure, a distinction is made between resting heart failure and exercise-induced heart failure. In resting insufficiency, symptoms already occur at rest, so in this case left heart failure would already be significantly advanced.
Causes
Left heart failure can occur as an acute event or develop insidiously-chronically. A variety of possible causes can be considered for left heart failure. The most important causes of left heart failure include coronary artery disease (CAD) and myocardial infarction. Both conditions are caused by progressive sclerosis of the coronary arteries. Myocarditis, an inflammation of the heart muscle, or dilated heart vessels, dilated cardiomyopathy, can also lead to left heart failure. Other causes include valvular heart disease, which may be congenital or acquired. In addition, most cardiac arrhythmias have the potential to result in left heart failure. Cardiac arrhythmias may or may not be associated with left heart ejection failure. Drug side effects, chemotherapy, or toxic effects of sepsis can also cause acute left heart strain with pervasive insufficiency. Even an otherwise normally functioning heart can develop transient left heart failure from excessive workload, for example, in the setting of hypertensive crisis.
Symptoms, complaints, and signs
When the heart is no longer able to provide blood flow to the organs, various symptoms occur. Possible signs of left heart failure include difficulty breathing and increased heart rate, associated with decreased exercise capacity. During the examination, the physician can often detect a third heart sound, the so-called gallop rhythm. In severe cases, this striking rhythm is noticed by the affected person himself. This is accompanied by pathological fluid accumulation in the lungs, pericardium or limbs. The severity of these symptoms depends on the stage of the disease. At the beginning, left heart failure can be noticed in particular by slight breathing difficulties, coughing fits and unusual nervousness. Subsequently, symptoms such as cold sweat and rales appear. Breathing is accelerated, often resulting in nighttime shortness of breath. Advanced left heart failure can lead to pulmonary congestion and, ultimately, to pulmonary edema. Due to the undersupply of muscles and brain, physical and mental performance gradually decreases, often accompanied by symptoms such as confusion, dizziness and other disorders of consciousness. Externally, left heart failure can be recognized by the blue coloration of the skin and mucous membranes and the film of sweat on the forehead and arms.
Diagnosis and course
Diagnosis aims to determine the causes of left heart failure and the resulting consequences, which can be reversible but also permanently severe. Initially, the primary care physician may initiate basic diagnostics using an electrocardiogram, ECG, or exercise ECG. Advanced diagnostics must be performed by a cardiologist or under outpatient conditions in a clinic. Even an ultrasound image of the heart muscle can provide indications of the degree of left heart failure.The cardiac catheter examination, coronary angiography, is performed under local anesthesia. Already during the examination, recognizable constrictions of the coronary vessels can be dilated and thus the blood flow can be improved again. Before any clinical examination, the patient’s medical history is of great importance. The patient describes his or her symptoms, which indicate the presence of left heart failure. Early signs of left heart failure are limited exercise tolerance and shortness of breath. If adequate therapy is not initiated, dyspnea and pulmonary edema, recognizable by rales on auscultation, occur as the disease progresses.
Complications
In the worst case, left heart failure can lead to the death of the affected person. For this reason, this disease must be urgently treated and examined by a physician to prevent secondary damage and other complications. Patients primarily suffer from shortness of breath. The reduced supply of oxygen also leads to permanent fatigue and exhaustion. Those affected suffer from feelings of anxiety and, not infrequently, from a tightness in the left side of the chest. Furthermore, there is also an inner restlessness and a loss of appetite. Those affected also frequently show water retention, which can have a very negative effect on everyday life. Frequent urination can also be caused by left heart failure. In the worst case, this disease leads to the death of the patient. Treatment of left heart failure can only be done with the help of medication. There is no surgical intervention in this case. Treatment can limit many symptoms. Complications do not occur. However, in severe cases, transplantation of a heart is necessary to prevent the patient’s death.
When should you go to the doctor?
When shortness of breath, rapid fatigue, and other typical signs of left heart failure are noticed, a visit to the doctor is recommended. Other alarm signs include coughing, rattling breath sounds and, occasionally, heart palpitations. Anyone who notices these symptoms should consult their family doctor or a cardiologist. At the latest, if serious breathing problems or cardiovascular complaints occur, this must be clarified medically. Left heart failure progresses progressively, which is why medical monitoring is necessary in every case. Persons suffering from a disease of the heart or the other organs in the chest and abdominal cavity should talk to the responsible specialist in case of unusual symptoms. If symptoms persist, it is best to see the cardiologist immediately. Increasing symptoms are a clear warning sign, which requires immediate clarification. If this is done at an early stage, left heart failure can be alleviated in many cases. Therefore, the general practitioner must be consulted in any case if unusual symptoms occur in the cardiovascular system. In addition, the nephrologist, a gastroenterologist, or even a neurologist may be consulted, depending on the underlying causes of left heart failure.
Treatment and therapy
Treatment of left heart failure should be based on the underlying cause. For all forms of heart failure, therapeutic principles should be followed according to the guidelines of the German Medical Association. Patients with heart failure must limit the daily amount they drink to 1.5 liters in order to keep cardiac workload as low as possible. If hypertension is present, medication is required. Various groups of medications are available for this purpose. Sometimes it takes some time to find the effective combination of drugs to lower blood pressure. In the case of acute left heart failure due to myocardial infarction with pulmonary edema, a so-called bloodless phlebotomy is performed as a therapeutic measure. In this procedure, venous return from the legs is temporarily throttled to relieve the heart. In cases of critical coronary perfusion, surgery may be indicated. In this case, so-called bypasses are created at the coronaries as collateral circulation. The vascular material required for this is usually taken from the leg veins. This procedure takes place under general anesthesia, and if successful, left heart failure can heal completely. The greatest risk factor after bypass surgery is re-sclerosis of the vessels.Patients with left heart failure are advised to follow a low-salt diet and should aim for normal weight. Excessive stimulant abuse damages the heart muscle,so patients with left heart failure should avoid nicotine and alcohol.
Outlook and prognosis
Without adequate medical care, the prognosis for left heart failure is unfavorable. The symptoms continuously increase in intensity and extent until ultimately heart failure occurs, leading to the premature death of the affected person. If complications occur in the further course of the disease despite treatment, the prognosis is also poor. Here, too, the disease can lead to the death of the patient in the worst case. If the diagnosis is made as quickly as possible and medical treatment is given without delay, the prospect of alleviating the existing symptoms improves. The stress on the heart must be kept as low as possible in the long term. Emotional as well as physical stress must be avoided and efforts of any kind must be reduced to a minimum. Otherwise, the risks for the onset of secondary disorders as well as the spread of the complaints will increase. Therefore, self-help measures can positively support the recovery process and should be applied immediately. With today’s medical possibilities, there are good therapeutic approaches that allow patients to continue living with the disease despite their existing heart failure. Long-term treatment, the administration of medication, control examinations and preventive measures are absolutely essential. Otherwise, the prospects of maintaining life deteriorate. Everyday life must be restructured and adjusted to the organism’s resilience.
Prevention
Heart failure can be prevented by effective therapy of diseases that can lead to damage of the heart muscle. Primarily, this involves coronary artery disease, hypertension, and dyslipidemia caused by high cholesterol. Risk factors should also be avoided. Excess weight must be reduced or obesity should be prevented in the first place. By also avoiding nicotine and excessive alcohol consumption, the risk of heart failure is significantly reduced. In this way, severe disease progression can be prevented.
Aftercare
Regular check-ups prevent the occurrence of possible complications or exacerbations, as these are detected in good time. However, affected individuals suffering from heart disease can also take some aftercare measures themselves, such as a healthy lifestyle with sufficient sleep and exercise in the fresh air. If any unusual feelings arise in the heart area during follow-up care, it is recommended that this be reported to the attending physician immediately. Diet also plays a major role in some heart diseases, so care should also be taken in this context not to eat too much fat.
What you can do yourself
Patients with left heart failure suffer from a condition that, in most cases, cannot be cured. Nevertheless, they can have a decisive influence on the course of their disease by changing their lifestyle, eating a healthier diet and exercising regularly. Whereas in the past patients with cardiac insufficiency were told not to exert themselves, today regular and adapted exercise is recommended. There are numerous cardiac sports groups where patients can exercise under qualified guidance and medical supervision according to their level of fitness. Another important aspect of heart failure is a healthy diet. Weight reduction is often the goal. A Mediterranean diet with plenty of fruit, vegetables, fish and olive oil is recommended. A lot of table salt in the diet can have a bad effect on the vessels and left heart failure. If possible, patients should avoid alcohol and nicotine altogether. After consulting with their doctor, patients with heart failure should often not exceed a certain amount of fluid to drink, as additional fluid puts a strain on the weakened heart. Stress in everyday life or at work is also an additional burden for the weakened heart, which should be avoided if possible. Additional relaxation exercises, such as progressive muscle relaxation or autogenic training, can be used here. It is also essential to take the prescribed medication regularly.
