A chest x-ray may be used to help diagnose and monitor heart failure.
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Heart failure can affect the left or right side of the heart. The left side pumps oxygen-rich blood from the lungs to the body, while the right side pumps oxygen-poor blood from the body back to the lungs. Congestive heart failure develops when the heart's pumping ability becomes impaired. Left-sided heart failure occurs more commonly than right-sided. As left heart failure progresses, however, a backflow of fluid into the lungs can ultimately affect the right side of the heart, leading to right heart failure.
Left Heart Failure
High blood pressure, coronary artery disease, viral infections, genetic disorders, certain medications, alcohol and other substance abuse are common triggers of left heart failure. When the left side of the heart becomes unable to pump blood effectively, fluid initially accumulates in the lungs. As a result, shortness of breath that limits physical activity is one of the first symptoms people with congestive, left-sided heart failure experience. Other initial symptoms of left heart failure include a persistent cough, difficulty breathing when lying down and swelling in the legs and ankles.
Complications of Left Heart Failure
Because left heart failure leads to a backup of blood in the lungs, other organs do not receive enough oxygen-rich blood. Symptoms of decreased blood flow to the brain, such as trouble with memory and concentration, affect people with advanced left heart failure. The kidneys are also vulnerable to poor blood flow in left heart failure. When the kidneys fail to receive enough blood and oxygen, kidney damage eventually occurs. Without treatment, most causes of left heart failure also lead to an enlarged heart. If the heart becomes dilated and enlarged, it is more prone to dangerous, abnormal heart rhythms -- another complication of left heart failure.
Right Heart Failure
According to authors of an April 2008 article in "Circulation," left heart failure is the most common cause of right heart failure. Other causes include heart defects present since birth, coronary artery disease and pulmonary hypertension, or high blood pressure in the lungs. When blood pressure rises in the lungs, the right side of the heart has to pump harder than usual, and right heart failure may develop. Pulmonary hypertension itself occurs due to blood clots in the lungs, autoimmune diseases, human immunodeficiency virus and liver disease. In many cases, the cause of pulmonary hypertension is unknown.
Complications of Right Heart Failure
The primary complication of right heart failure is a condition called congestive hepatopathy -- meaning an accumulation of fluid in the liver. When the right heart becomes too weak to pump blood to the lungs, blood backs up into the liver. The buildup of fluid in the liver eventually leads to a decline in liver function that prompts even more swelling in the legs and ankles. Fluid, called ascites, may also accumulate in the abdomen. Left untreated, congestive hepatopathy can progress to what is known as cardiac cirrhosis. Cardiac cirrhosis, in turn, can ultimately lead to liver failure.
Both left and right heart failure typically respond to treatment with medications, including diuretics, beta blockers and angiotensin-converting enzyme inhibitors. In certain cases, however, heart failure becomes so severe that symptoms no longer respond to medicinal therapy. People who primarily have left heart failure may be candidates for a mechanical device called a left ventricular assist device, or LVAD. An LVAD is a surgically implanted device that takes over the pumping function of the left heart. A heart transplant may be considered for people with both left and right heart failure.