Heart failure
Biventricular heart failure
What is biventricular heart failure?
The ventricle on the left side of your heart pumps oxygenated blood from your lungs out into your body, and the ventricle on the right side pumps used blood from your body back into your lungs to be re-oxygenated.
When neither side is working as it should you have biventricular heart failure.
If your left ventricle isn’t pumping properly, your heart will be unable to push blood out to your body efficiently and it will struggle to draw blood from your lungs.
If your right ventricle isn’t pumping properly, your heart will be unable to pull blood from your body and push it out to your lungs efficiently.
Background information
Heart failure (also known as congestive heart failure) is a syndrome caused by the heart’s inability to pump strongly enough to supply the body and lungs with as much blood as they need. It is a chronic, or long-term, condition, and it is the result of a wide range of different heart and circulation disorders, some treatable, some not.
Heart failure develops when your heart’s lower chambers, the ventricles, fail to fill properly with blood during the relaxed phase of your heartbeat and then don’t push enough blood out when they contract. Your heart is working hard, but it isn’t working effectively, and the result is high levels of pressure inside your heart and fluid accumulation in your lungs and other parts of your body.
It is very common among elderly adults – it affects about 10% of people over 70 years old – and is usually categorized as left heart failure, right heart failure, or biventricular (both sides) heart failure. Left heart failure is the most common type.
If left untreated, heart failure can be deadly, and so if you develop the signs and symptoms of heart failure – swollen legs and feet, swollen abdomen, and difficulty breathing – you should talk with your doctor.
In a normal heart, the ventricles should be able to squeeze 50% to 75% of their blood out into the body or the lungs with each contraction. In a failing heart, that percentage, which is called the ejection fraction, will be 40% or less.
People with biventricular heart failure experience a mix of symptoms of both left and right heart failure.
Take a look at Your heart: The basics if you’d like to know more about how the normal heart works.
What causes biventricular heart failure?
Heart failure can have many different causes. Anything that damages the heart or interferes with its ability to function can ultimately cause heart failure.
Biventricular heart failure usually begins as left heart failure that then progresses to the right side of your heart and causes it also to fail. Anything that causes either left or right heart failure can ultimately lead to biventricular heart failure.
Common causes of left heart failure include:
- Coronary artery disease
- Heart damage from a previous heart attack
- Heart valve disorders, particularly mitral valve regurgitation
- Hypertension
- Arrhythmias, particularly atrial fibrillation and atrial flutter
- Heart inflammations or infections, such as myocarditis
- Cardiomyopathy (weakened or enlarged heart muscle)
- Smoking and excessive drinking may increase your risk of heart failure, as may obesity.
Common causes of right heart failure include:
- Problems with pulmonary (lung) circulation
- Left heart failure
- Coronary artery disease
- Heart damage from a previous heart attack
- Heart valve disorders, particularly tricuspid valve regurgitation
- Hypertension
What are the symptoms of biventricular heart failure?
If you have biventricular heart failure you will probably experience symptoms common to both left and right heart failure.
Swelling, or edema, of the feet and legs
Fluid build-up in your lungs may make breathing difficult, and cause chronic coughing, and you may experience swelling in your legs, feet, and abdomen.
Another symptom, which is related to fluid build-up, is nocturia, or frequent urination at night. This happens because, when you lie down, the extra fluid in your legs and feet moves back toward the middle of your body, and your kidneys then go into overdrive to try to flush it out.
Common symptoms of biventricular heart failure include:
- Swelling in the feet, legs, and abdomen
- Coughing
- Difficulty breathing, even with mild exercise and often when lying down
- Rapid heartbeat
- Chest discomfort
- Tiredness
- Nocturia: Frequent urination at night
How is biventricular heart failure treated?
Your doctor will determine the best course of treatment based on the severity of your heart failure and will focus on treating its underlying causes. Not all causes of biventricular heart failure can be treated.
Treatments may include medications to help your heart to pump more effectively, and diuretics to reduce your fluid load and help you to manage symptoms such as swollen feet and ankles.
If your heart failure is severe, your doctor may recommend surgery to implant a pacemaker or an ICD (implantable cardioverter defibrillator). In the most severe cases, a cardiac assist device or heart transplantation may be required.
Treatments for biventricular heart failure include:
- Lifestyle changes: Quitting smoking, losing weight, moderate exercise
- Medication to improve your heart’s ability to pump
- Diuretics to reduce your fluid load
- Surgical insertion of a pacemaker or ICD (in severe cases)
- Cardiac assist device to help your heart pump (in severe cases)
- Heart transplantation (in severe cases)
What are the aims of treatment?
The aims of treatment for people with biventricular heart failure are to relieve symptoms like breathlessness and swelling, to help your heart to beat more effectively, and to prevent or slow further weakening of your heart muscles.