Left ventricular failure (LVF) occurs when the left ventricle (the heart’s main pumping chamber) can no longer maintain adequate output, causing blood to back up into the pulmonary circulation. Fluid leaks from the pulmonary capillaries into the lung tissue, producing pulmonary oedema.
Symptoms include sudden or progressive breathlessness (particularly on lying flat, known as orthopnoea), a persistent cough (sometimes producing frothy or pink-tinged sputum), severe breathlessness at night (paroxysmal nocturnal dyspnoea), reduced exercise tolerance, and in severe cases a feeling of drowning. In extreme cases, reduced forward cardiac output causes peripheral circulatory failure and can progress to cardiogenic shock.
LVF can be acute (sudden onset, a medical emergency requiring immediate hospital treatment) or chronic (developing gradually as part of progressive heart failure). Common causes include large heart attacks, cardiomyopathy, severe valve disease, and uncontrolled hypertension. Cardiac arrest survivors may experience transient LVF due to myocardial stunning in the immediate post-arrest period.
Acute LVF is treated in hospital with oxygen, diuretics (to remove fluid), vasodilators, and, if needed, ventilatory support. Longer-term management of chronic LVF follows heart failure treatment guidelines, including disease-modifying medications and cardiac rehabilitation.
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