Left- or right-sided heart failure

Right-sided heart failure

When the right side of the heart is failing, it can’t handle the blood it is getting from the rest of the body. This blood returns to the heart through veins. When too much pressure builds up in the veins, fluid leaks out into the tissues. Gravity then causes that fluid to move to those parts of the body that are the lowest. So one of the first symptoms of right-side HF can include swelling in the feet and ankles. If the condition gets worse, the swelling can even go up past the knees. Sometimes it gets so severe, the liver and intestines can get congested as well.

Left-sided heart failure

When the left side of the heart is failing, it can’t handle the blood it gets from the lungs. Pressure then builds up in the veins of the lungs. This causes fluid to leak into the lung tissues. As a result, you feel short of breath, weak, or dizzy. These symptoms are often worse with physical activity, such as when climbing stairs or walking up hills. Lying with your head flat is uncomfortable and can make your breathing worse. It may make sleeping difficult. You may need to use extra pillows to elevate your upper body to sleep well. The same is true when just resting during the daytime. You may also feel weak or tired and have less energy during exertion.

Heart failure can have many causes. They include:

• Coronary artery disease

• High blood pressure

• Previous heart attack

• Diabetes

• Obesity

• Alcohol abuse

• Smoking

• Illegal drug use, such as methamphetamine

• Family history

• Inflammatory conditions including infection

• Unknown cause (idiopathic)

Heart failure is usually a long-term (chronic) condition. The purpose of treatment is to improve how well the heart pumps and to remove extra water from the body. A number of medicines can help. They can improve symptoms and prevent the heart from becoming weaker. In certain cases, cardiac procedures or surgery can help to treat heart failure. Sometimes heart failure can become so severe that a device is placed in the heart to help it pump. Or a heart transplant is advised. Another major goal is to better treat the causes of heart failure, such as diabetes and high blood pressure. You may also need to make some lifestyle changes.

Home care

Follow these guidelines when caring for yourself at home:

• Check your weight every day. This is very important because a sudden increase in weight gain could mean the heart failure is getting worse. Keep these things in mind:

  • Use the same scale every day.

  • Weigh yourself at the same time every day. Wear similar clothing or no clothes at all.

  • Make sure the scale is on a hard floor surface, not on a rug or carpet.

  • Keep a record of your weight every day so your healthcare provider can see it. If you are not given a log sheet for this, keep a separate journal for this purpose. 

• Cut back on the amount of salt (sodium) you eat. Follow your healthcare provider's advice on how much salt or sodium you should have each day.

  • Limit high-salt foods. These include olives, pickles, smoked meats, salted potato chips, and most prepared foods.

  • Don't add salt to your food at the table. Use only small amounts of salt when cooking.

  • Read the labels carefully on food packages to learn how much salt or sodium is in each serving in the package. Remember that a can or package of food may contain more than 1 serving. So if you eat all the food in the package, you may be getting more salt than you think.

• Improve your diet by including more fresh foods, cutting back on how much sugar and saturated fat you eat, and eating fewer processed foods.

• Follow your healthcare provider's advice about how much fluid you should have. Be aware that some foods such as soup, pudding, and juicy fruits like oranges or melons contain liquid. You'll need to count the liquid in those foods as part of your daily fluid intake. Your provider can help you with this.

• Stop smoking, if you smoke.

• Don't use illegal drugs.

• Limit how much alcohol you drink.

• Lose weight if you are overweight. The extra weight puts a lot of stress on the heart.

• Stay active. Talk with your provider about an exercise program that is safe for your heart.

• Keep your feet elevated to reduce swelling. Ask your provider about support hose to prevent daytime leg swelling.

Follow-up care

Follow up with your healthcare provider, or as advised.

Make sure to keep any appointments that were made for you. These can help better control your heart failure. You will need to follow up with your provider on a routine basis to make sure your heart failure is well managed.

If an X-ray, electrocardiogram (ECG), or other tests were done, you will be told of any new findings that may affect your care.

Call 911

Call 911 if you:

• Become very short of breath

• Feel dizzy, lightheaded, or like you might pass out or faint

• Have chest pain or discomfort that is different than usual, the medicines your provider told you to use for this pain don't help, or the pain lasts longer than 10 to 15 minutes

• Develop a rapid or irregular heart rate

When to seek medical advice

The following may be signs that your heart failure is getting worse. Call your healthcare provider right away if any of these happen:

• Sudden weight gain. This means 2 or more pounds in 1 day, or  5 or more pounds in 1 week, or as advised by your provider

• Trouble breathing not related to being active

• New or increased swelling of your legs or ankles

• Swelling or pain in your abdomen

• Breathing trouble at night, causing you to wake up short of breath or need more pillows to breathe

• Frequent coughing that doesn’t go away

• Feeling much more tired than usual