From the Guidelines
Left heart failure primarily manifests as pulmonary congestion due to increased pressure backing up into the lungs, with common symptoms including shortness of breath, fatigue, and exercise intolerance. The symptoms of left heart failure (Left Ventricular Failure) can be understood by considering the impact of the condition on the body's ability to manage fluid and maintain effective circulation. According to the ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult 1, patients with advanced heart failure often experience symptoms related to the retention of salt and water, which can be managed through interventions designed to restore sodium balance.
Key Symptoms
- Shortness of breath (dyspnea), especially during exertion or when lying flat (orthopnea)
- Paroxysmal nocturnal dyspnea (waking up breathless at night)
- Fatigue
- Exercise intolerance
- Coughing, particularly at night, sometimes with frothy or blood-tinged sputum
- Physical examination may reveal crackles (rales) in the lungs, an S3 gallop heart sound, and peripheral edema, especially in the ankles and feet
As the condition progresses, patients may develop pulmonary edema with severe breathlessness, pink frothy sputum, and respiratory distress requiring emergency treatment. These symptoms occur because the left ventricle cannot effectively pump blood forward into the systemic circulation, causing blood to back up into the pulmonary veins and capillaries. This increased pressure forces fluid into the alveolar spaces, impairing gas exchange and causing respiratory symptoms. Early recognition of these symptoms is crucial for timely intervention to prevent acute decompensation and improve quality of life, as emphasized in the guidelines 1.
From the Research
Symptoms of Left Heart Failure
The symptoms of left heart failure, also known as left ventricular failure, can be debilitating and affect a patient's quality of life. Some of the common symptoms include:
- Shortness of breath (dyspnea) 2, 3, 4, 5, 6
- Fatigue 2, 4, 5, 6
- Peripheral oedema 4, 5
- Pain 4
- Cough 5
- Orthopnea 5
- Paroxysmal nocturnal dyspnea 5
- Edema 5
Pathophysiology and Causes
Left heart failure is a complex clinical syndrome that results from impaired cardiac relaxation or contraction 4. The causes of symptoms in left heart failure can be different from those in other types of heart failure, and may be related to factors such as: