Left Vs. Right-sided Heart Failure

Disclaimer: This article is purely for the purpose of providing information, and should not be used as a substitute for medical advice.

Heart failure occurs when the heart does not manage to pump enough blood in the body. When the demands of the body are not met by the pumping of the heart, it implies that the functioning of the heart has been compromised. Heart failure can be chronic or acute in nature. It can occur due to low output or high output of blood. It can also occur due to sectional failure of the heart, that is, due to failure of only the right side or the left side.

Left-sided Heart Failure Vs. Right-sided Heart Failure

Causes
The main cause of left-sided heart failure is often directly or indirectly related to a cardiac ailment. Hypertension can trigger it, as can ischemic heart disease, aortic or mitral valve disease or any kind of cardiomyopathy. Right-sided heart failure, on the other hand, usually follows left heart failure, due to its association with pulmonary hypertension and pulmonary congestion. Besides this, the causes of latter also include disease of the lungs, a valvular heart disease or a congenital heart disease.

Symptoms
Although the general symptoms of heart failure apply to both, there are certain features that can help differentiate between right and left-sided heart failure. Left-sided heart failure normally compromises the aortic blood flow, which is directly linked to blood flow to the body and brain. When there is left heart failure, the person tends to feel more and more breathless on any kind of physical exertion. PND or paroxysmal nocturnal dyspnea is also quite common. The person will often seem fatigued, low on energy, and will also complain of chest pain. If it is a case of acute left heart failure, then tachycardia (i.e. very high heart rate), facial pallor but central cyanosis, cold extremities and profuse sweating may also be seen. A characteristic pattern of breathing, known as Cheyne Stokes respiration is also seen in this case. There are waning and waxing periods of respiration seen, interposed by slower breathing and recurring periods of apnea. Pulmonary edema may also accompany this form of cardiac asthma. On ausculatation, there may be basal crepitations or coarse bubbling sounds heard.

When there is right-sided heart failure, then there is usually generalized weakness and fatigue felt. The person will be constantly breathless (even without exertion) and will have cough as well. Abdominal pain and distension may also be seen, which may make the person lose his appetite, to an extent that he may become anorexic. The person will also complain of generalized symptoms, like headache, insomnia, restlessness, edema of the legs and feet and decreased urinary output. Other symptoms include cyanosis, warm extremities, engorged veins in the neck, an increase in the jugular pressure and at times, even an enlarged and tender liver. If right heart failure has been brought on by left heart failure, then there will be enlargement of the heart.

Tests and Diagnosis
A chest X-ray will help to see if there is any cardiac enlargement. Usually, when there is left heart failure, there will be cardiomegaly and pulmonary congestion. If there is pulmonary edema then the X-ray will have the classic 'bat wing appearance' of the lungs. In case of right-sided heart failure, the X-ray will not easily reveal cardiomegaly of the right-side. Pleural effusion of right or both sides may be present. Usually, in such cases, due to the symptoms of oliguria or nocturia, a urine test is also called for. The urine will show high specific gravity, along with presence of albumin, due to the resultant renal congestion. If a blood test is done, then it may also correspondingly show an increase in the blood urea levels.

In case of left-sided heart failure, the treatment is often targeted at reducing the symptoms and relieving stress on the heart to make sure that the condition doesn't worsen. As right-sided heart failure follows left-sided heart failure in most of the cases, the treatment for the same generally revolves around the treatment of left-side. The prognosis of this condition is dependent on many factors, including the main underlying cause and the general health of the patient. In either case, immediate care needs to be given to any patient that is showing signs of heart failure, as the road to recovery is a long one, which will include constant monitoring and quite a few healthy lifestyle changes.