Left-sided heart failure

Alternative names:

congestive heart failure - left

Treatment:

The goals of treatment include reduction of cardiac work load, control of symptoms, and improvement of heart functioning.

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

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

Medications include diuretics to reduce fluids in the body, and vasodilators to reduce the work load of the heart (examples include captopril, enalapril, and hydralazine). Digitalis may be given to help the heart muscle contract more vigorously.

Intravenous medications may be used to give a faster response, including 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 intra-aortic 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 (congenital heart defect corrective surgery)

Expectations (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

Calling your health care provider:

Call your health care provider if symptoms indicate 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.