What are the symptoms of left-sided heart failure?

Francisco J. Jimenez-Carcamo, MD
Cardiology (Cardiovascular Disease)
Left-sided, or left ventricular (LV), heart failure occurs when the left side of the heart must work harder to pump enough blood to meet the body's needs. The left ventricle is larger than the other chambers of the heart and provides most of the heart's pumping power.
The two types of left-sided heart failure are:
  • Systolic failure: The left ventricle can't contract normally.
  • Diastolic failure (diastolic dysfunction): The muscle has become stiff and the left ventricle can't relax normally, so it doesn't fill with blood completely. 
The common symptoms of left-sided heart failure include:
  • fatigue
  • shortness of breath, particularly when lying down
  • persistent coughing or wheezing
  • edema (buildup of fluid in body tissues that causes swelling)

Symptoms for left-sided heart failure include fatigue, weakness, and shortness of breath. Left-sided heart failure is the most common form of heart failure. During left-sided heart failure, fluid accumulates in the lungs. At first, the accumulation may be small resulting in shortness of breath during periods of exertion. As heart failure worsens and more fluid accumulates, breathing may become difficult, even at rest. A person experiencing left-sided heart failure may wake from sleep gasping for air. These symptoms can be eased by sitting up, because the gravity allows the fluids to drain to the bottom of the lungs. A person suffering from advanced heart failure may experience an unusual breathing pattern (Cheyne-Stokes) characterized by episodes of rapid and deep breathing followed by several seconds without breath. This unusual breathing pattern is caused when the brain receives low-oxygenated blood.

Left-sided heart failure is often called "backward" heart failure.  This refers to symptoms that are predominately respiratory in nature.  Patients with left-sided heart failure often have shortness of breath otherwise known as dyspnea.  The dyspnea they may suffer may be with mild or moderate exertion.  Often times, patients may be dyspneic at rest.  Patients also have shortness of breath while lying flat.  This is referred to as orthopnea.  Patients may decrease this symptom by sleeping on an increasing number of pillows secondary to this uncomfortable feeling.  Another related symptom of left-sided heart failure is paroxysmal nocturnal dyspnea.  This is a sudden episode of shortness of breath that occurs usually at night after achieving sleep.  This is often ameliorated by patients sitting up and perhaps even walking around in order to regain their breath.  Other symptoms of left-sided heart failure may include wheezing.  This is often referred to as cardiac asthma.  In summary, left-sided heart failure refers to heart dysfunction that reflects backward into the pulmonary circulation resulting in the conditions mentioned above.
Joan Haizlip, MSN
Cardiology (Cardiovascular Disease)
  Symptoms for left sided heart failure are related to fluid buildup in the lungs, making it hard to breathe:


- shortness of breath (dyspnea)


- unable to lie flat (orthopnea) and need to use multiple pillows to sit up to sleep



Jennifer H. Haythe, MD
Cardiology (Cardiovascular Disease)
When the left side of the heart is failing, the symptoms include shortness of breath at rest or with exertion, fatigue, exhaustion, low energy and palpitations.

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