Types of Heart Failure: Left-Sided, Right-Sided, & More - Verywell Health

Heart failure is what happens when your heart is not pumping enough blood throughout the body. It does not mean the heart has stopped working. Instead, it means your heart is not strong enough to pump blood properly or is not able to fill up with a sufficient amount of blood. This article discusses the different types of heart failure.

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Heart Failure Overview

There are about 6.2 million adults in the United States with heart failure. Heart failure can be acute, which means it happens quickly. Or it can develop over time as your heart becomes weaker. This is considered chronic heart failure.

Heart failure often occurs because of another medical condition that causes heart damage, including:

Heart failure can affect other parts of the body, including the kidneys and liver. This is why it is so important to see a doctor for heart failure and manage it properly. With the right treatments, many people with heart failure can live a long, fulfilling life.

Types of Heart Failure

There are several anatomical types of heart failure:

You have probably also heard of congestive heart failure. This is not a type of heart failure; rather, it is a symptom that can occur with any of the three types listed above.

It is also possible to have more than one type of heart failure.

Left-Sided Heart Failure

The left side of your heart pumps blood throughout the body. With left-sided heart failure, the left ventricle, also known as the lower left chamber, does not pump blood as well as it normally should or cannot fill with blood properly. Left-sided heart failure is the most common type of heart failure.

Symptoms of Left-Sided Heart Failure

Symptoms include:

  • Chest pain
  • Exercise intolerance
  • Fast or irregular heartbeat
  • Fatigue
  • Edema (swelling in the tissues, such as in ankles or wrists)
  • Shortness of breath
  • Weakness

Diagnosis and Typing

A type of measurement called ejection fraction is used to assess how effectively the heart pumps blood. An ejection fraction measurement can help indicate the type of left-sided heart failure you have:

  • Systolic heart failure is used to indicate that the left ventricle muscle cannot pump blood well. The ejection fraction is below normal. This is also called heart failure with reduced ejection fraction.
  • Diastolic heart failure is used to indicate that the left ventricle does not fill with blood as it should during the diastolic phase. The ejection fraction is normal or close to normal. This is also called heart failure with preserved ejection fraction. With diastolic heart failure, the left ventricle pumps properly but pumps out less blood than it normally would.

It is useful to know your ejection fraction if you have heart failure. Here's what the ejection fraction numbers mean:

  • An ejection fraction of 55% to 70%: The heart is pumping normally. You may have a normal heart function or heart failure with preserved ejection fraction.
  • An ejection fraction of 40% to 54%: The heart's pumping ability is a little below normal.
  • An ejection fraction of 35% to 39%: The heart has a moderately below-normal pumping ability. This indicates mild heart failure with reduced ejection fraction.
  • An ejection fraction of less than 35%: The heart's pumping ability is severely below normal. There is very often moderate to severe heart failure with reduced ejection fraction.

Treatment

Although left-sided heart failure cannot be cured, there are treatments to help manage it. Treatments are usually tailored depending on the cause of the heart failure. Treatments for left-sided heart failure include:

  • Making lifestyle changes, such as getting more physical activity and eating a heart-healthy diet
  • Reducing salt intake to help avoid or reduce a buildup of fluid in the body
  • Taking medications such as angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and diuretics. There are many types of medications used for left-sided heart failure.
  • Having surgery to help repair a blocked artery or a narrow or leaky heart valve

Right-Sided Heart Failure

Left-sided heart failure is a frequent cause of right-sided heart failure. However, other conditions can cause right-sided heart failure, including certain lung diseases like chronic obstructive pulmonary disease or pulmonary hypertension.

Symptoms of Right-Sided Heart Failure

Symptoms of right-sided heart failure are similar to those of left-sided heart failure, although they can be more severe. These symptoms include:

  • Confusion
  • Fatigue
  • Shortness of breath even after a short amount of activity
  • Swelling in the ankles and lower part of the body as well as the abdomen, chest, and thighs (also called edema)
  • Swollen and painful liver

Treatment

Treatments for right-sided heart failure will depend on its cause. Common treatments include:

  • Surgical repair if the cause is valvular heart disease
  • Use of medications such as diuretics to help reduce edema, or swelling
  • Lifestyle changes such as a low-fat/low-sodium diet and gentle aerobic exercise
  • In severe cases, a heart transplant

Like left-sided heart failure, right-sided heart failure does not have a cure. However, you can use the various treatments to help manage it.

Biventricular Heart Failure

Heart failure more commonly occurs on the left side of the heart but then can expand to the right side. Biventricular heart failure is used to describe heart failure that is present in both the left and right sides of the heart. The symptoms include fatigue, shortness of breath, and swelling. You would follow the treatments as recommended by your doctor, including medications, surgery, and lifestyle changes.

What About Congestive Heart Failure?

You may hear some health professionals use the terms congestive heart failure or heart failure interchangeably. However, congestive heart failure can occur with any of the three types discussed earlier, its hallmark being the accumulation of fluid, especially in the lungs, producing pulmonary congestion.

Congestive heart failure is when blood flow from the heart becomes slower than it should. This leads to a buildup of blood returning to the heart through the veins, which usually leads to swelling in the ankles, legs, and sometimes other parts of the body. It is also possible for fluid to back up in the lungs, leading to breathing problems that become worse when laying down.

Chronic heart failure is different from cardiac arrest, which is used to describe when the heart stops beating.

Symptoms of Congestive Heart Failure

Sometimes, congestive heart failure does not have symptoms. When it does, those symptoms include:

  • Fatigue
  • Irregular heartbeat
  • Shortness of breath
  • Swelling in the legs

Treatment

Treatments for congestive heart failure include:

  • Taking medications like ACE inhibitors, diuretics, and vasodilators
  • Having surgery to replace heart valves or open clogged arteries
  • Following a low-sodium diet and avoiding or limiting caffeine

Doctors may monitor and treat other conditions that are linked to congestive heart failure, including sleep apnea.

A Word From Verywell

Although heart failure does not mean the heart has stopped working completely, it is still a serious medical condition that requires medical attention and management. In addition to guidance from your doctor, you can make changes in your life to improve heart failure. For instance, you may plan to walk regularly for physical activity and make low-sodium food choices.

If you are not diagnosed with heart failure but have the symptoms of it, such as shortness of breath, let your doctor know.

Frequently Asked Questions

  • Coronary heart disease is the most common type of heart disease. This can limit blood flow to the heart and increase the chances of a heart attack.

  • Cardiologists often use the following groupings from the New York Heart Association to describe heart failure:

    • Class I: No symptoms and no limitation in ordinary physical activity; for instance, no shortness of breath when walking or climbing stairs
    • Class II: Mild symptoms such as mild shortness of breath and/or chest pain and slight limitation during ordinary activity
    • Class III: Marked limitation in activity due to symptoms even during less-than-ordinary activity such as walking short distances; comfortable only at rest
    • Class IV: Severe limitations and experiencing symptoms even while at rest; mostly bedbound patients

  • The warning signs of heart failure include:

    • Coughing and wheezing
    • Fatigue
    • Shortness of breath
    • Swelling around the ankles, legs, and thighs
    • Inability to do normal activities because you tire easily

    It is important to see a doctor to get the right diagnosis and receive any necessary treatments.

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