Heart failure may affect the right side, the left side, or both sides of the heart. The left side of the heart receives blood rich in oxygen from the lungs and pumps it to the remainder of the body. As the ability to pump blood forward from the left side of the heart is decreased, the remainder of the body does not receive enough oxygen especially when exercising. This results in fatigue.

In addition, the pressure in the veins of the lung increases, which may cause fluid accumulation in the lung. This results in shortness of breath and pulmonary edema.

Common causes of left-sided failure include the following:

• Heart attack
• Chronic blockages of the heart arteries
• High blood pressure
• Excessive alcohol consumption
• Leaking or narrow heart valves
• Hypothyroidism
• Heart muscle infections
• Any other disease that damages the heart muscle

In children, common causes include heart birth defects such as abnormal heart valves, abnormal blood vessel connections, or viral infections.

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

• Shortness of breath
• 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
• Weight gain from fluid retention
• Decreased urine production (oliguria)
• Infants may have poor feeding, weight loss, and failure to thrive

Physical examination may reveal an irregular or rapid heartbeat and increased rate of breathing. Listening to the heart may reveal heart murmurs or extra heart sounds, and listening to the lungs may reveal crackles or decreased breath sounds at the bottom. The skin of the legs may have excessive fluid and may remain dimpled when pressed.

Tests may include the following:

• Electrocardiogram (ECG) may show evidence of prior heart attack, an enlarged heart, or abnormal heart rhythm.
• Chest X-ray may show an enlarged heart and fluid in or around the lungs.
• Ultrasound of the heart (echocardiogram): poor pumping action of the heart, leaking or narrow heart valves.
• Blood tests to evaluate thyroid, liver, and kidney function.
• Stress test to evaluate for heart disease.
• Coronary angiography to evaluate blockages in the heart arteries.

The goals of treatment include treating the underlying disease, relieving stress on the heart and minimizing symptoms and risks of worsening heart failure.

• Consultation with a heart specialist is recommended.
• Hospitalization may be required when symptoms are severe.
• Treatment of underlying disease may include opening blocked heart arteries by either cardiac catheterization or bypass surgery, treatment of high blood pressure, or avoidance of heart toxins such as alcohol.
• Decreasing salt intake, avoiding alcohol and doing moderate exercise as tolerated are recommended.
• Diuretics (medication to accelerate removal of body water) such as furosemide (Lasix) or spironolactone (Aldactone) are given to treat fluid retention
• Medications to decrease heart stress, such as beta blockers and ACE inhibitors, are also given. These medications also prevent further muscle damage and scarring, especially when the heart muscle is weak.
• Digoxin may be given to increase muscle strength and slow down abnormally fast heart rates.

In severe cases, IV medications are given to promote water removal and to increase heart pumping function.

A number of studies have shown that heart failure symptoms can be improved with a special type of pacemaker. It paces both the right and left sides of heart. This is referred to as biventricular pacing or cardiac resynchronization therapy. Ask your provider if you are a candidate for this.

In very severe cases in which medicines alone are not sufficient, mechanical devices to assist the left heart in pumping blood can be implanted. Heart transplantation may need to be performed based upon availability of a donor heart.

Heart failure is a serious disorder that carries a possibility of reduced life expectancy. Prognosis depends upon the underlying disorder, and the age and tolerated level of activity of the patient.

In many cases, there is little chance for full recovery of heart function. However, many forms of heart failure are well controlled with medication and can remain stable for many years with occasional exacerbations of symptoms.

• Pulmonary edema
• Total failure of the heart to function (circulatory collapse)
• Abnormal heart rhythms
• Side effects of medications
  • Low blood pressure (hypotension)
  • Lightheadedness, fainting
  • Headache
  • Chronic cough
  • Low electrolyte levels
  • Difficulty with sexual intercourse