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Types of Heart Failure

Left-sided heart failure
The heart's pumping action moves oxygen-rich blood as it travels from the lungs to the left atrium, then on to the
left ventricle, which pumps it to the rest of the body. The left ventricle supplies most of the heart's pumping power,
so it's larger than the other chambers and essential for normal function. In left-sided or left ventricular (LV) heart
failure, the left side of the heart must work harder to pump the same amount of blood.
There are two types of left-sided heart failure. Drug treatments are different for the two types.

Systolic failure: The left ventricle loses its ability to contract normally. The heart can't pump with
enough force to push enough blood into circulation.

Diastolic failure (also called diastolic dysfunction): The left ventricle loses its ability to relax normally
(because the muscle has become stiff). The heart can't properly fill with blood during the resting period
between each beat.

Right-sided heart failure

The heart's pumping action moves "used" blood that returns to the heart through the veins through the right
atrium into the right ventricle. The right ventricle then pumps the blood back out of the heart into the lungs to be
replenished with oxygen.
Right-sided or right ventricular (RV) heart failure usually occurs as a result of left-sided failure. When the left
ventricle fails, increased fluid pressure is, in effect, transferred back through the lungs, ultimately damaging the
heart's right side. When the right side loses pumping power, blood backs up in the body's veins. This usually
causes swelling or congestion in the legs, ankles and swelling within the abdomen such as the GI tract and liver
(causing ascites).

Congestive heart failure

Congestive heart failure is a type of heart failure which requires seeking timely medical attention, although
sometimes the two terms are used interchangeably.
As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion
in the body's tissues. Often swelling (edema) results. Most often there's swelling in the legs and ankles, but it can
happen in other parts of the body, too.

Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when
a person is lying down. This is called pulmonary edema and if left untreated can cause respiratory distress.
Heart failure also affects the kidneys' ability to dispose of sodium and water. This retained water also increases
swelling in the body's tissues (edema).

This content was last reviewed on 04/06/2015.

Classes of Heart Failure

1.8K

Updated:Sep 30,2015

Doctors usually classify patients' heart failure according to the severity of their symptoms. The table below
describes the most commonly used classification system, the New York Heart Association (NYHA) Functional
Classification. It places patients in one of four categories based on how much they are limited during physical
activity.

Cla
Patient Symptoms
ss

No limitation of physical activity. Ordinary physical activity

does not cause undue fatigue, palpitation, dyspnea
(shortness of breath).

II

Slight limitation of physical activity. Comfortable at rest.

Ordinary physical activity results in fatigue, palpitation,
dyspnea (shortness of breath).

III

Marked limitation of physical activity. Comfortable at rest.

Less than ordinary activity causes fatigue, palpitation, or
dyspnea.

Unable to carry on any physical activity without discomfort.

Symptoms of heart failure at rest. If any physical activity is
undertaken, discomfort increases.

IV

Cla
Objective Assessment
ss
A

No objective evidence of cardiovascular disease. No

symptoms and no limitation in ordinary physical activity.

Objective evidence of minimal cardiovascular disease. Mild

symptoms and slight limitation during ordinary activity.
Comfortable at rest.

Objective evidence of moderately severe cardiovascular

disease. Marked limitation in activity due to symptoms, even
during less-than-ordinary activity. Comfortable only at rest.

Objective evidence of severe cardiovascular disease. Severe

limitations. Experiences symptoms even while at rest.

For Example:

A patient with minimal or no symptoms but a large pressure gradient across the aortic valve or severe
obstruction of the left main coronary artery is classified:
o

Function Capacity I, Objective Assessment D

A patient with severe anginal syndrome but angiographically normal coronary arteries is classified:
o

Functional Capacity IV, Objective Assessment A

This content was last reviewed on 04/06/2015.