LEFT HEART

FAILURE
By: DR AREMU TAIWO

OUTLINES

Definition
Epidemiology
Causes
Symptoms
Signs
Investigations
Treatment
Prevention

Definition
Left-sided heart failure is a lifethreatening condition in which
the left side of the heart cannot
pump enough blood to the body.
Alternative Names
Congestive heart failure - left

Epidemiology
Incidence:

Left-sided heart failure

occurs in approximately 1
to 3 of every 100 people
and becomes more
prevalent with age.

Prevalence:
Persons younger than 50 years are hardly
ever found to have heart failure, but in
those older than 50 years the prevalence
and incidence increase progressively with
age. In a recent US populationbased study
the prevalence of heart failure was 2.2%,
increasing from 0.7% in persons aged 45
through 54 years to 8.4% for those aged
75 years or older.

Prevalence Contd
These figures are highly comparable
to previous studies, such as the
Rotterdam study (prevalence of heart
failure being 1% in age group 5564
years, 3% in age group 6574 years,
7% in age group 7584 years, and
over 10% in those aged 85 years).

Causes and risk factors

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 leftsided 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

Common causes in children:

In children, common causes include
heart birth defects such as:

1)abnormal heart valves,

2)abnormal blood vessel
connections, or
3)viral infections.

Symptoms
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

Signs
Physical examination may reveal:
an irregular or rapid heartbeat
increased rate of breathing (tachypnoea)
Listening to the heart may reveal heart
murmurs or extra heart sounds
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 (bilateral pitting pedal oedema)

Investigations
Chest x-ray: may show
- Alveolar oedema with bilateral hilar
adenopathy, taking a bat wing appearance
- Kerley B lines
- Cardiomegaly (an enlarged heart) with
cardiothoracic ratio of more than 50%
- Upper lobe diversion with prominent upper
lobe vessels
- Pleural effusion, fluid in or around the lungs.

Investigations Contd.
Electrocardiogram (ECG) may show evidence of prior
heart attack, an enlarged heart, or abnormal heart
rhythm.
Ultrasound of the heart (echocardiogram): poor
pumping action of the heart, leaking or narrow heart
valves.
Stress test to evaluate for heart disease.
Coronary angiography to evaluate blockages in the
heart arteries.

Investigations Contd.
Blood chemistry (Serum E/U/Cr)
B-type natriuretic peptide (BNP)
Complete blood count
Liver function tests (LFT)
Thyroid function tests
Urinalysis
Fasting lipid profile

Treatment
The goals of treatments are:
Treat the disease that is causing the
heart failure
Reduce symptoms
Relieve stress on the heart
Reduce risks of worsening heart failure:
eat less salt, avoid alcohol, and exercise
moderately.

Some medications
include:
Diuretics such as furosemide (Lasix) 20-80mg
daily or spironolactone (Aldactone) 50-400mg
daily to help the body get rid of extra fluid
Beta blockers (such as metoprolol 100-200mg
or carvedilol 12.5mg daily )and ACE inhibitors
(Lisinopril 2.5-40mg daily, Enalapril 5-40mg daily) to
reduce the stress on the heart and to prevent
further muscle damage and scarring
Digoxin (0.75-1mg daily) to increase muscle
strength and slow down abnormally fast heart
rates

Treatment Contd
When heart function decreases
significantly, a defibrillator may be
recommended to prevent sudden
cardiac death. A defibrillator is used
to prevent dangerous heart rhythms,
which often occur in people with very
weak hearts.

Treatment Contd
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.

Treatment Contd
In very severe cases, when
medicines alone do not
work, a heart pump
(ventricular assist device)
can be implanted. A heart
transplant may be needed.

Prevention
In an effort to prevent further heart
damage:
Stop smoking or chewing tobacco.
Reach and maintain healthy weight.
Control high blood pressure,
cholesterol levels and diabetes.
Exercise regularly .
Do not drink alcohol.

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