The heart’s right and left sides perform different jobs to keep blood moving through the body. When either side becomes too weak or stiff to function effectively, the result may be heart failure -- a condition in which the heart cannot adequately meet the body’s need for blood and oxygen.
Although heart failure may involve one or both sides of the heart, understanding where the problem begins can help doctors identify its cause, anticipate symptoms and recommend treatment. Dr. Lindsey Aurora, a cardiologist at Henry Ford Health, explained the differences between left- and right-sided heart failure and why early care matters.
How left-sided heart failure affects the heart
Left-sided heart failure is more common than right-sided heart failure. The left side of the heart receives oxygen-rich blood from the lungs, and the left ventricle pumps that blood throughout the body.
Left-sided heart failure generally falls into one of two categories:
- Systolic heart failure: The heart muscle does not squeeze strongly enough to pump an adequate amount of blood into circulation. Doctors may also refer to this as heart failure with reduced ejection fraction.
- Diastolic heart failure: The heart muscle becomes stiff and does not relax normally between beats. As a result, the ventricle cannot fill properly with blood. This is also called heart failure with preserved ejection fraction.
“Left-sided heart failure can often be the result of other health conditions,” Dr. Aurora said. “For example, having coronary artery disease or high blood pressure can cause more stress on the heart and require it to work harder.”
Several other health and lifestyle factors may contribute to left-sided heart failure, including:
- Poorly controlled diabetes
- Obesity
- Aging
- Thyroid conditions
- Smoking or excessive use of alcohol or drugs
- Certain chemotherapy or radiation treatments
- A family history of heart failure or inherited heart conditions
Why right-sided heart failure develops
The right side of the heart collects blood returning from the body and sends it to the lungs to receive oxygen. Right-sided heart failure occurs when the right ventricle is unable to pump effectively.
In many cases, the condition begins with a problem on the left side of the heart. When the left ventricle cannot move blood forward properly, pressure may build in the blood vessels of the lungs. Over time, this added pressure can place stress on the right side of the heart.
“The left ventricle offers the pumping power needed for the heart to circulate blood,” Dr. Aurora said. “When the left ventricle can’t pump properly, increased fluid pressure can be transferred back through the lungs - which can affect and damage the right side of the heart. Decreased function of the right ventricle can cause blood to back up and collect in the body and veins leading to symptoms such as swelling in your legs i.e. fluid retention.”
Because blood may begin to back up in the veins, right-sided heart failure is often associated with fluid accumulation in the legs, ankles, abdomen or other areas of the body.
Recognizing possible heart failure symptoms
Left- and right-sided heart failure may cause many of the same warning signs. Symptoms alone cannot determine which side of the heart is affected, so a medical evaluation and appropriate testing are necessary.
“Heart failure can also present itself differently from person to person,” Dr. Aurora said. “Our goal is to identify your condition early and help you manage it diligently.”
Possible symptoms of heart failure include:
- Shortness of breath during activity, while resting or when sleeping
- A persistent cough
- Swelling in the legs, ankles or abdomen
- Unexplained weight changes
- Excessive tiredness
- Difficulty completing everyday activities
- Nausea
- Loss of appetite
Contact your doctor if you develop new or worsening symptoms -- particularly if they interfere with your usual activities or make it difficult to breathe.
How heart failure is treated
Heart failure can range from a manageable chronic condition to a serious illness requiring advanced care. A person’s treatment plan will depend on which side of the heart is affected, the underlying cause and the severity of the condition.
Some people can manage heart failure with medication, lifestyle changes and careful monitoring. Others may need procedures or surgery to improve blood flow and heart function. In advanced cases, treatment could include a heart transplant or an artificial heart pump.
“Your outcomes depend on the severity of your case and factors associated with your heart failure,” Dr. Aurora said. “Left versus right sided heart failure can also dictate differences on the treatment recommended.”
Specialists consider the full picture -- including other medical conditions, heart function and symptoms -- to determine the most appropriate treatment and help prevent heart failure from progressing.
Taking steps to protect your heart
Not every case of heart failure can be prevented, but addressing known risk factors may help protect the heart and reduce unnecessary strain. You can also be intentional about leading a healthy lifestyle:
- Eat a nutritious, heart-healthy diet
- Quit smoking and avoid recreational drugs
- Maintain a healthy weight
- Participate in regular physical activity as recommended by your doctor
- Following your treatment plan for high blood pressure, diabetes and other medical conditions
- Keeping regular appointments with your healthcare providers
“The best thing that you can do is to monitor your health, be proactive and seek medical attention if you begin experiencing any new symptoms,” Dr. Aurora said. “Our hope is that consistent follow-up with healthcare providers will provide patients the opportunity for the best quality of life.”
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