Left Ventricular Failure

The left ventricle is the lower left sided chamber among the 4 chambers of the heart. It pumps pure blood to the entire body via the aorta. Therefore, good functioning of the left ventricle is vital for good perfusion and hence good functioning of the entire body. There are certain conditions which put strain on the left ventricle. Thus when subjected to strain for a long time, the functioning of the left ventricle becomes sluggish. Over a period of time, after this, its failure commences. Hypertension is the most common condition causing a left ventricular failure. Because of increased resistance in the peripheral vessels, the left ventricle has to pump blood with greater force and becomes sluggish over a period of months to years resulting in left ventricular failure. Apart from hypertension, coronary artery disease is also a major cause for left ventricular failure. Due to poor perfusion of the heart, its function starts getting impaired. Abnormalities of the valves of the heart are also a cause for left ventricular failure. Congenital heart diseases, i.e. those present since birth lead to left ventricular failure in childhood. Disease of the cardiac muscle whether due to infection or metabolic conditions like uncontrolled diabetes, uremia due to renal failure, e.t.c., deranges the functioning of the left ventricle resulting in cardiac failure. Toxic substances like alcohol and tobacco damage the cardiac muscle and cause left ventricular failure. Left ventricular failure can be sudden in onset or start gradually and become chronic. To begin with a person experiences breathlessness on exertion and finds that he is unable to do his routine work well. As the disease progresses he starts feeling breathless even while sitting or resting. Due to the biological rhythm of the body, he usually feels suffocation and shortness of breath after midnight which compels him to sit upright. Sitting up straight makes him feel comfortable. Along with breathlessness, he also has cough with expectoration. As the forward flow of blood is impaired due to sluggish functioning of the left ventricle, the blood tends to flow back in the left auricle and lungs. This produces cough with breathlessness and expectoration. These symptoms are very similar to bronchial asthma, hence it is also called, “cardiac asthma”. The two can be differentiated only by the fact that bronchial asthma is episodic and in between the person is mostly normal. In bronchial asthma, there is a definite relation of symptoms to climate changes or exposure to allergy producing substances. But in cardiac asthma, once the person gets sick, he keeps on deteriorating unless treated. The symptoms also are not related to climate changes. There is also associated palpitations which occur due to the over activity of the failing heart to maintain circulation. Due to poor perfusion of vital parts and , disturbed sleep the individual starts feeling tired very easily. He also has loss of appetite which adds to the weakness. Once the function of the left ventricle is deranged, it produces pressure on the right ventricle, leading to total heart failure and its attendant complications. Strong suspicion is needed to diagnose left ventricular failure.Like right ventricular failure, it does not produce peripheral signs like swelling of the feet and body and enlargement of the liver. Diagnosis is confirmed by X-ray chest, electrocardiography, echocardiography and other imaging techniques. If treatment is started early, the functioning of left ventricle can improve to a great extent. Treatment of the underlying cause also helps in improvement of the condition. It is imperative to keep conditions like hypertension and diabetes very well under control with life style changes and medicines to prevent development of left sided heart failure. Congenital heart diseases and valvular abnormalities when treated by surgery in early stages help in reversal of the left ventricular failure and regaining of the normal function. Government of Rwanda is doing a great job by getting surgeries done for children and adults with surgically correctable heart problems, thus reducing the burden of heart failure. One should also quit smoking and alcohol to prevent damage to the heart.Once heart failure starts, it is prudent to take the prescribed medicines regularly to avoid further extension of the problem. rachna212002@yahoo.co.ukMusanze-12th July 2011