Heart failure is a significant public health concern in terms of prevalence, mortality rates, and economic burden. Left ventricular dysfunction or LV dysfunction of the heart is usually followed by congestive heart failure which ultimately leads to a multitude of cardiac disorders thereafter. Hence it’s a priority concern for the healthcare sector, especially in countries like India which have a high proportion of patients afflicted by the disease.
What is Left Ventricular Dysfunction/LV Dysfunction?
The left ventricle is the thickest chamber of the heart which is primarily responsible for pumping oxygenated blood to the vital organs of the body. LV dysfunction occurs when the left ventricle is either defective or damaged, thus disrupting healthy .
Normal LV function can be disturbed due to several causes. Certain cardiac defects like valvular malformations or diseases block the passage of blood into the body. This compels the left ventricle to work harder and pump blood faster to compensate for the lack of oxygen-rich blood in the body tissues. Over time, the heart muscles become thicker, weaker and the walls stretch to accommodate more blood. This eventually leads to ventricular dysfunction, especially left ventricular dysfunction.
Signs and Symptoms of LV Diastolic Dysfunction
The term diastolic refers to the heartbeat stage when the cardiac muscles relax, allowing blood to flow in and fill the chambers. LV diastolic dysfunction is the condition in which the relaxation process of the heart is disturbed as the left ventricle has become stiffer than normal. This causes weakening of the heart and subsequent heart failure. Shortness of breath on exertion or when you’re at rest (lying flat) can be a certain sign of advanced heart failure.
Indications that you have left ventricular diastolic dysfunction are:
- Waking up at night with shortness of breath
- Shortness of breath or feeling of exertion while at rest
- Bouts of chest pain
- Shortness of breath during mild activity
- Extreme fatigue and weakness
- Nausea and lack of appetite
- Irregular heartbeat
- Excessive urination
- Dizziness and fainting
- Swelling in your feet, ankles, and abdomen
Tests to Diagnose LV Dysfunction
To examine the extent of damage due to left ventricular dysfunction, cardiologists prescribe the following tests:
- An array of blood tests: To test abnormal levels of certain blood components
- Echocardiogram: Sound waves are used to obtain video data of your heart’s condition
- Electrocardiogram: Measures electrical signals
- Chest X-ray: Checks heart size to test for enlargement and congestion
- Exercise tests: To judge how the heart reacts during stress
- Cardiac catheterization: A long slender tube is inserted into the vein or artery at the neck, arm, or groin. It is then slowly moved through the blood vessels to the heart. This catheter can then be used to diagnose the damage to the heart valves.
- Coronary angiography: For patients who show signs of angina or ischemic chest pain
Left Ventricular Dysfunction Treatment Options
Patients with mild LV dysfunction can keep heart failure at bay with proper medications. Common prescriptions for left ventricular dysfunction are:
- Diuretics or water pills: Treats swelling of feet and abdomen
- Beta-blockers: Slows heart rate and regulates blood pressure
- ACE inhibitors, ARB, ARNI: Widen blood vessels
- Mineralocorticoid receptor antagonist: Rids the body of excess salt and fluid but retains potassium
- Nitrates and Hydralazine: Relaxes and further widens blood vessels
- Digoxin: Assists in the pumping process of the heart
Apart from medicinal treatments, patients should also welcome certain lifestyle changes to help ease complications due to LV dysfunction:
- Maintain a balanced diet
- Maintain a regular exercise regimen
- Quit smoking and alcohol
- Avoid consuming foods rich in cholesterol and saturated fats
- Restrict the intake of excess fluids
- Keep body weight in check
Surgery for severe LV dysfunction
In cases of severe LV dysfunction, doctors may prescribe surgical solutions for treatment. Depending on the symptoms and stage of left ventricular dysfunction, there are three such procedures:
- Coronary artery bypass: A surgical procedure to improve the flow of blood into the arteries by targeting and removing blockages in the blood passage.
- Valve Repair or replacement surgery: LV dysfunction sometimes occurs due to faulty cardiac valves, in which case this type of surgery is carried out where the valve is replaced with a donor or prosthetic valve. In case the valve is not compromised completely, the valve can be repaired to restore normal or near-normal blood flow. However, patients may have to take blood-thinning medication for the rest of their life in the case of valve repair.
- Use of a defibrillator: A defibrillator is used to return the heart to its normal rhythm. A defibrillator works by sending an electrical signal or shock to the heart muscle which restores the normal heartbeat and revives it. Implantable defibrillators may also be used, such devices generally have a pacemaker built into it to stop the heart from beating too fast or too slow.
- Heart transplant: For extremely severe LV dysfunction, doctors advise heart transplant procedures.
- What is the life expectancy of patients diagnosed with left ventricular systolic dysfunction?
Life expectancy depends on which stage the LV dysfunction has reached. Patients who avail of diagnosis and treatment at early stages tend to have a better outlook and longer life than those who are diagnosed during later stages. Generally, 50% of patients with left ventricular dysfunction go one to live beyond 5 years after being diagnosed.
2. What are some of the treatment guidelines for left ventricular diastolic dysfunction?
LV diastolic dysfunction is not 100% curable but patients can ease their suffering and improve their heart health by consuming the proper dosage of targeted medications, adopting healthy lifestyle changes, and undergoing surgeries if the doctor recommends.
3. Can severe LV dysfunction be cured?
There is no cure for severe LV dysfunction that leads to heart failure. Personalized treatment plans prescribed by experienced cardiologists can help improve health conditions and quality of life.
4. How can LV function be restored?
Devices called defibrillators are used to restore normal LV function. It sends an electrical pulse or shock through the heart to bring back a regular heartbeat. Left ventricular dysfunction may cause sudden cardiac arrest in which case, defibrillators can restore heart function.
Dr. Priyankar Sinha | Senior Consultant – Cardiac Surgery – Adult | Narayana Institute of Cardiac Sciences, Bommasandra, Bangalore