The importance of the heart as a critical organ is common knowledge, so is the fact that it pumps blood to the different parts of the body. Fresh oxygenated blood is needed by every small cell and tissue to respire and produce energy. Energy production at the cellular level is extremely important because it enables muscles to work exactly like an individual wants.
Just like every organ of the body needs to be in good shape for it to function properly, the heart also needs to be healthy so that the pumping action is carried out seamlessly. What really does the ‘health of the heart’ mean? A healthy heart is one whose muscles have not been damaged and the ventricles work with each other in unison.
People who have healthy lifestyles that include exercise regimes are known to keep their heart healthy; and as a result, their body and mind are fit and alert. One of the most common habits that affect heart health in the worst possible manner is smoking. Smoking weakens the muscles of the heart and destroys the lungs- an organ that partners with the heart to ensure adequate oxygen reaches all cells and tissues.
Hence, an unhealthy heart is the beginning of Cardiovascular Diseases that can cripple an individual and reduce the quality of his life immensely. According to the American Heart Association, Cardiovascular Diseases are the #1 cause of death globally, taking away 17.3 million deaths per year. At this rate, the figure is expected to reach 23.6 million by the year 2030.
One prominent type of Cardio Vascular Disease is Heart Failure. Heart failure is the inability of the heart to pump enough blood to the body. While it doesn’t stop functioning altogether, the heart fails to pump just enough blood, making the body weak and disrupting essential chemical processes.
There are many different types of heart failures. Each of these is characterized by the location of the weakness and the reasons for it. Broadly speaking, there are three types of heart failures: Congestive Heart Failure left sided Heart Failure and Right-Sided Heart Failure. For the scope of this article, left sided Heart Failure will be discussed, with some highlights on the difference between right and left sided heart failure.
Difference Between Right And Left Sided Heart Failure
Left sided heart failure is a medical emergency in which the left ventricle of the heart is not pumping enough oxygenated blood to the body. A healthy heart’s pumping actions move fresh, oxygen-rich blood from the lungs to the left atrium, from where it goes into the left ventricle to be circulated throughout the body.
Since the left part of heart is responsible for distributing fresh blood, the left ventricle is the largest chamber compared to the other three. Therefore, it normally has a lot of power to ensure regular circulation. In the event of a Left sided Heart Failure, the left ventricle has to put extra energy to pump the same amount of blood as before.
Therefore, while the heart function doesn’t halt completely, it reduces to an extent that this crucial organ comes under distress, leading to an emergency. Also known as Left Ventricle (LV) Heart Failure, this condition also puts added pressure on the lungs, risking their health as well. The most common symptom of left sided heart failure is the collection of fluid in the lungs.
There are two types of LV conditions that dictate the symptoms of left sided heart failure.
In Systolic failure the left ventricle is unable to contract like it should. Thus, losing its ability to pump enough blood throughout the body.
Diastolic Failure: The left ventricle is unable to relax like it should. Thus, losing its ability to fill up with enough blood that will be circulated throughout the body.
To understand the difference between right and left sided heart failure, it is important to take a look at the function of the right side of the heart. While the left side is pumping blood, the right side of the heart collects ‘used’ blood. The same pumping action makes this blood move from the right atrium to the right ventricle and then to the lungs to be replenished with oxygen.
Right Sided Heart Failure, also known as Right Ventricle (RV) Failure is a result of the weakening of the left side of the heart because the function of both is correlated to each other. Once the left side of heart has failed, the build up of pressure in the lungs translates into pressure in the right ventricle. As a result of the loss of pumping power on the right, blood starts to collect in the veins.
Pathophysiology Of Left Sided Heart Failure
Pathophysiology of left sided heart failure means the pathophysiological processes that change, or are altered, by the body as left sided failure continues. These processes are directly linked to the symptoms of left sided heart failure because the more the disease progresses, the greater the intensity of the symptoms.
Pathophysiology of left sided heart failure includes:
• Reduced contractility of the ventricle as it is loaded with more and more blood.
• Reduced stroke volume, which is a result of an irregular systole or diastole.
• Hemodynamic, which is the dynamics of the flow of oxygenated blood, is affected adversely.
• Cellular changes in the heart walls, included programmed death of cells known as Apoptosis.
Symptoms of Left Sided Heart Failure
The effects of left sided heart failure are devastating. Since the entire body relies on the left side of the heart for its blood, any irregularity in its function leads to severe side effects. During the early stages, the symptoms of left sided heart failure may not surface persistently.
Most of the symptoms discussed below appear and disappear rather quickly pre-failure, which is why many patients do not realize their heart is weak till it cannot bear the responsibility of pumping blood to the entire body. Doctors and physicians, who classify patients with a high risk of heart disease, keep an eye out for the sudden onset of any of the symptoms of left sided heart failure- no matter how subtle.
Shortness of Breath:
Shortness of breath is most common symptom of left sided heart failure. Breathing becomes difficult when blood supply to the lungs and other parts of the body. Shortness of breath becomes very painful because it robs a patient’s ability to do anything at all.
Since fluid collects in the lungs as an effect of left sided heart failure, a patient coughs a lot. This cough is not dry; instead it is accompanied by the spitting of blood-tainted or frothy mucus.
Difficulty Lying Down:
Owing to shortness of breath, a patient may have difficulty in lying down when the head falls back. In this condition, the head needs to stay elevated so that the breathing pipes and nasal passage have enough room to inhale and exhale.
Palpitations is a medical term given to the sensation of hearing or feeling heartbeats. When the heart is working too hard to pump blood, its pumping or beating can be heard.
Irregular or Rapid Pulse:
Again, because of the increased effort that the heart is putting into circulating blood, the pulse increases and reaches a point where it can be felt as ‘throbbing.’
Fatigue and Weakness:
The energy in our body comes from a regular supply of blood to the cells and tissues. With this oxygen, they respire and produce energy to complete activities and essential tasks. When the supply of oxygenated blood reduces, the cells experiences fatigue, which spreads to all muscles.
As a result of fatigue and weakness, a patient can also end up fainting. When the brain doesn’t receive enough fresh blood, it fails to stay conscious. Faintness is also an effect of left sided heart failure that puts the body in a low-energy mode.
Another symptom of left sided heart failure, weight gain is a result of fluid retention. As mentioned previously, weakness in the heart leads to a collection of fluid in the lungs and surrounding regions. A patient records more weight, which is attributed to the weight of the liquids in the body. As left sided heart failure prognosis is made, total body weight is an important indicator.
Decreased Urine Production:
Medically known as Oliguria, this condition is a result of decreased functionality of the kidneys as they are deprived of oxygen-rich blood. An output of more than 80ml/day but less than 400ml/day is classified as Oliguria.
Failure to Thrive:
this symptom of left sided heart failure is seen in infants and adolescents who are still in the growing age bracket. Abnormal pumping function can make the body weak and thus, unable to grow and thrive as it should.
when fresh, oxygenated blood fails to reach the cognitive centres of the brain, patient experiences low alertness levels. Difficulty in concentrating on conversations is also a part of this symptom.
Swelling or Edema in the body is a common symptom of left sided heart failure, after it has had an affect on the right side as well. Since the used blood cannot be pumped efficiently back to the lungs, it starts collecting in large veins found in the legs and arms. Vein swelling is extremely dangerous because the sensitive blood vessels can perforate or rupture if the pressure of blood becomes too high.
Treatment of Left Sided Heart Failure
Treatment of left sided heart failure is a long and thorough process. As a left sided heart failure prognosis is made, the treatment options available are discussed and implemented. Fortunately, medical science has advanced a great degree in today’s day and age. Complicated procedures and tests can be conducted within a matter of hours. Such advancement has made treatment of left sided heart failure and its detection effective and thorough.
When a patient is thought to have had a left sided heart failure, or is about to suffer from it, the first step is to do a thorough physical exam. A physical exam will reveal a rapid pulse, palpitations or a heart murmur when heartbeats are heard carefully. Doctors also focus on listening to sounds, if any, in the lungs. These sounds indicate decreased breathing at the bottom of the lungs, which is directly linked to the symptoms of left sided heart failure.
Moreover, a patient’s legs and arms are also checked to observe swelling or the collection of excess fluid just below the surface of the skin. Before treatment of left sided heart failure begins, a number of tests are also carried out including:
• Chest X-ray to check fluid collection
• An ECG to hear heart rhythms
• Blood tests
• Stress tests
• Heart ultrasounds
If the results of the above tests are not in the normal ranges, treatment for left sided heart failure can begin. Treatment options aim to:
• Reduce symptoms
• Treat the condition causing left sided heart failure
• Reduce chances of worsening
With these goals in mind, the treatment for left sided heart failure involves medicines as well as surgery. Heart surgery or heart catheterization is performed to check for blockades in the blood vessels of the heart. If there are any, these blockades are cleared out to restore blood supply and regular pressure of circulation.
Medications are prescribed to control blood pressure, to calm the patient, relieve the heart of added stress and to treat any effects of left sided heart failure like Oliguria. Mostly, these medicines are given via an IV. Post surgery, if the patient is still not out of harm’s way, a defibrillator is used to prevent dangerous heart rhythms.
Medications that are commonly used include:
• Diuretics like furosemide to get rid of excess fluids in the body.
• Strengthening medications like Digoxin to make the heart muscles stronger and prevent irregular heart beats.
• ACE inhibitors and Beta-blockers to scarring and advanced muscle damage in the heart and other organs affected by symptoms of left sided heart failure.
While medication and surgery are useful treatment options, left sided heart failure prognosis often indicates little chances for the heart to recover fully in most patients.